psych nursing ppt 1
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Psych nursing lecture notes part 1TRANSCRIPT
PSYCHIATRIC NURSING
• MENTAL HEALTH– Is a balance in a
person’s internal life and adaptation to reality.
• MENTAL ILLNESS– Is a state of imbalance
characterized by disturbance in a persons thoughts, feelings and behaviours
• PSYCHIATRIC NURSING– Is an interpersonal
process whereby the professional nurse practitioner, through the therapeutic use of self and nursing theories assist clients to achieve psychosocial well-being.
• PERSONALITY– Integration of systems and
habits representing an individuals characteristics adjustments to his environment expressed through behaviours.
• MENTAL HYGEINE– Measures to promote
mental health, preventing mental illness and suffering and facilitate rehabilitation.
SELF AWARENESS
• Is a clear perception about your personality, including strength and weakness, thoughts, beliefs, motivations and emotions.
• It is knowing:– What you want in your life – Your strength and weaknesses– What you want to change
about yourself or about your life
– Your achievements so far– How to relate to others– What you need to improve as a
person– Your most important beliefs
and values– How you see yourself as a
person
NEUROSIS
• Any long term mental or behavioural disorder in which contact to reality is retained, the condition is recognized by the patient as abnormal.
PSYCHOSIS
• Mental or behavioural disorder wherein a patient looses contact with reality.
• Presence of delusions, hallucinations, thought disturbances, alteration of mood, abnormal behaviour.
COMMON BEHAVIOURAL TERMS
• DISTURBANCES in PERCEPTION– Illusion– Hallucination• Auditory• Visual• Tactile
DISTURBANCES IN THINKING and SPEECH
• Neologism• Word Salad• Verbigeration• Perseveration• Echolalia• Aphasia• Ambivalence• Flight of Ideas• Looseness of association• Clang association
• Delusion– Delusion of Grandeur– Persecutory– Ideas of Reference– Somatic
• Concrete Association• Magical thinking
DISTURBANCES in AFFECT
• Inappropriate• Blunt • Flat• Depersonalization• Derealization• Agnosia
DISTURBANCES in MOTOR ACTIVITY
• Echopraxia• Waxy Flexibility• Ataxia• Akathesia• Dystonia• Tardive Dyskenisia• Apraxia
DISTURBANCES in MEMORY
• Confabulation• Déjà vu• Jamais vu• Amnesia– Retrograde– anterograde
Satisfaction of Human needs
• Physiologic• Safety and security• Love and belongingness• Self-esteem• Self-actualization
Three divisions of the Mind
• Conscious• Subconscious• Unconscious
THEORIES OF PERSONALITY DEVELOPMENT
• SIGMUND FREUD– Psychosexual Theory– Structure of Personality
• ID• EGO• SUPEREGO
• ERICK ERICSON– Psychosocial Theory
• JEAN PIAGET– Cognitive Theory
• Lawrence Kohlberg– Moral Development Theory
DEFENSE MECHANISMS
• Unconscious intrapsychic adoptive efforts to resolve emotional conflict and cope with anxiety
EXAMPLES of DEFENSE MECHANISMS
• Denial• Displacement• Projection• Introjection• Undoing• Compensation• Substitution• Repression• Supression
EXAMPLES of DEFENSE MECHANISMS
• Reaction formation• Regression• Dissociation• Conversion• Fantasy• Identification• Intellectualization• Rationalization• Sublimation
NURSE-PATIENT RELATIONSHIP
• Is a series of interaction between the nurse and patient in which the nurse assists the patient to attain positive behavioural change.
– T: trust– R: rapport– U: unconditional positive regard– S: setting limits– T: therapeutic communication
PHASES
• Pre-interaction– Self-awareness
• Orientation – Developing a mutually acceptable contact
• Working– Identification and resolution of the patient’s problem
• Termination– Assist patient to review what he has learned and
transfer his learning to his relationship with others
When to terminate NPR
• Goals are accomplished• Emotionally stable• Greater independence• Able to cope with anxiety, fear, loss and
separation
• Common effect: regression
Common problems in NPR
• Transference• Counter-transference
Principles of CARE
• Accept patient as unique with inherent value and worth
• Patient is viewed as holistic human beings with interdependent and interrelated needs
• Focus on the patient’s strength’s and assets.• Non-judgemental assistance towards coping• Explore the patient’s behaviour and the need
to meet the message it is communicating
Therapeutic Communication
• Offer self• Exploration• Silence• Active listening• Make observation• Broad Opening• Clarification• Restating• General leads• Refocusing• focusing
Non-therapeutic Communication
• “don’t worry be happy”• “why?”• Ignoring• Flattery• Arguing with the patient
TYPES of PSYCHOTHERAPIES
• Remotivation therapy• Music Therapy• Play therapy• Group therapy• Milieu therapy• Family therapy• Hypnotherapy• Behaviour modification
• Types of behavioural modification:– Operant conditioning– Desensitization– Aversion
PSYCHOPHARMACOLOGY
• Are the use of medication to treat or control mental and behavioural problems.
ANTI-PSYCHOTICS/NEUROLEPTICS
• PHENOTHIAZINES– chlorpromazine (Thorazine)– fluphenazine (Prolixin)– perphenazine (Trilafon)– prochlorperazine (Compazine)– thioridazine (Mellaril)– triflouperazine (Stelazine)
• NON-PHENOTHIAZINES– clozapine (Clozaril)– haloperidol (Haldol)– olanzapine (Zyprexia)– resperidone (Risperdal)
Mechanism of Action
• Antagonizes dopamine in the CNS by blocking dopamine receptors and reducing dopamine activity.
• INDICATION:– Relieves psychotic symptoms of schizophrenia and
mania– Acute management of agitation and hyperactivity
Side/Adverse effects
• Extrapyramidal Side effect– Acute dystonia– Pseudoparkinsonism
• Stiff stooped posture• Mask-like faces• Shuffling, festinating gait• Drooling• Pill rolling tremors/resting tremor
– Akathisia– Torticollis– Opisthotonus– Oculogyric crisis
Side/Adverse effects
• Neuroleptic Malignant Syndrome– Rigidity– High fever– Unstable BP– Diaphoresis and pallor– Elevated enzymes: creatinine and phosphokinase– Confused/mute
• Discontinue medication ASAP!
Side/Adverse effects
• Tardive dyskinesia– Involuntary movements of the tongue, facial and
neck muscle– Tongue protrusion and thrusting– Lip smacking– Blinking– grimacing
Contraindication
• Glaucoma• Pregnancy and lactation• Elderly clients
Nursing Guidelines
• Give the medication after meals• Instruct the client to rise slowly from a lying
position• Instruct the client to report sore throat, fever or
muscular rigidity• Inform the client that the medication will achieve
its full therapeutic effect within 6-8 weeks• Monitor client’s BP and body temperature, blood
levels, presence of seizure, NMS and EPS
ANTIDOTES• NMS– bromocriptine or amantadine– dantrolene– Muscle relaxants
• Dystonia– dyphenhydramine– benztropine– diazepam– lorazepam
• Pseudoparkinsonism– Antiparkinsonian
• Tardive dyskinesia– Early referral- dose reduction
ANTIPARKINSONIAN AGENTS
• Dopaminergic drugs– Enhances dopamine activity, slows deterioration
of dopaminergic nerve cells
• carbidopa-levodopa (Sinemet)• amantadine (Symmetrel)• bromocriptine mesylate (Parlodel)• levodopa (Larodopa)
ANTIPARKINSONIAN AGENTS
• Anticholinergic Agents– Inhibit excess in cholinergic activity– Decreases signs and symptoms like:• Tremors, rigidity, drooling, and promotes optimal
levels of motor functions (gait, posture, speech)
• trihexypheiedil (Artane)• biperidine Hydrochloride (Akineton)• benztropine myselate (Cogentin)• diphenhydramine HCL (Benadryl)
• Side Effects– Blurring of vision, constipation, orthostatic
hypotension, sorethroat*, headache, photosensitivity, drowsiness
• Contraindications– Glaucoma, tachycardia, hypertension, duodenal
ulcer
Nursing Guidelines
• Inform the client that tremors and rigidity will be decreased after 2-3 days of drug therapy
• Give the medication after meals• Avoid sudden position change• Inform the client to avoid Vit. B6 and protein rich
foods• Encourage the client to avoid alcohol
consumption• Do not withdraw the medication abruptly
ANTIDEPRESSANTS
• TRICYCLIC ANTIDEPRESSANTS– Prolongs the action of norepinephrine dopamine
and serotonin by blocking the reuptake of this neurotransmitters
• imapramine (Tofranil)• amitriptyline (Elavil)• clomipramine (Anafril)• doxepin (sinequan)
ANTIDEPRESSANTS
• MONOAMINE OXIDASE INHIBITORS– Blocks the metabolic destruction of
neurotransmitters by the enzyme monoamine oxidase
• tranylcypromine (Parnate)• isocarboxacid (Marplan)• phenelzine (Nardil)
ANTIDEPRESSANTS
• Selective Serotonin Reuptake Inhibitors– Inhibits reuptake and destruction of serotonin to
prolong its action
• fluoxetin (Prozac)• paroxetine (Paxil)• sertraline (Zoloft)• fluvoxamine (Luvox)
ANTIDEPRESSANTS
• CNS STIMULANTS– Increases levels of neurotransmitters in the brain
thereby increasing CNS activity and decreasing hyperactivity
• methylphenidate (Ritalin)• amphetamine (Benzedrine)
SIDE EFFECTS
• TCA’s– Cardiac arrhythmias– Palpitation, orthostatic hypotension– Constipation– Sedation, Confusion
• MAOI– Hypertensive crisis– Liver and cardiovascular disease– Weight gain– Sexual dysfunction– Photosensitivity
SIDE EFFECTS
• SSRI’s– Tremors– Decreased libido– Nervousness– Insomnia– Anxiety
• CNS stimulants– Growth suppression – insomnia
CONTRAINDICATIONS
• Liver disease• Cardiovascular disease• Glaucoma• Hypertension
NURSING GUIDELINES
• TCA’s– Give the medication after meals.– Inform the client that the initial effect of the
medication happen after 2-3 weeks.– Tell the client that the full therapeutic effect
occurs within 3-6 weeks of compliance– Emphasize compliance of medication regimen– Avoid citrus foods– Monitor client’s BP, HR, and ECG
NURSING GUIDELINES
• MAOI– Give the medication after meals– Inform client that initial effect of the medication
occurs after 2-3 weeks– The full therapeutic effect is achieved after 3-4
weeks– Avoid tyramine rich foods– Monitor BP and food items
NURSING GUIDELINES
• SSRI– Give the medication after meals– Initial effect occur after 2-3 weeks of therapy– Full therapeutic effect is achieved after 3-4 weeks
• CNS STIMULANTS– Give the medication in the morning or before 2
PM
ANTI-MANIC
• Alters the level of dopamine and other neurotransmitters.
– lithium carbonate (Eskalith)– carbamazepine (Tegretol)
SIDE EFFECTS
• Fine tremors leading to coarse tremors• Thirst• Nystagmus• Nephrotoxicity• Cardiac toxicity• Hyperthyroidism
CONTRAINDICATION
• Cardiovascular disorders• Renal disorders• Hyponatremia• On diuretic therapy• Brain damage• Pregnancy and lactation
NURSING GUIDELINES
• Inform client that the initial effect occurs after 10-14 days
• Full therapeutic effect is achieved within 3-4 weeks of drug compliance
• Give the medication with food or milk or after meals• Instruct the client to include sodium rich foods in
the diet not exceeding to 6-10 grams a day• Tell the client to avoid caffeine, diuretics and
activities that increase perspiration
NURSING GUIDELINES
• Monitor serum levels once a month in the morning 12 hours after the last dose– Maintenance dose: .5 – 1.2 mEq/L– Acute level : 1.5 mEq/L– Level for the elderly client: .4 -10 mEq/L
• Antidote for lithium toxicity– mannitol (Osmitrol)– acetylzolamide (Diamox)
ANTI ANXIETY
• Depresses the reticular activating system and reduces anxiety by stimulating the action of neurotransmitter GABA
ANTI ANXIETY• BENZODIAZEPINES
– alprazolam (Xanax)– chlordiazepoxide (Librium)– diazepam (Valium)– lorazepam (Ativan)– oxazepam (Serax)
• AZASPIRONES– buspirone (Buspar)
• NON-BENZODIAZEPINES– hydroxyzine (Vistaril)– meprobamate (Equanil)
SIDE EFFECTS
• Sedation, dizziness, drowsiness• Dry mouth• Dependency• hepatotoxicity
CONTRAINDICATIONS
• Glaucoma• Liver and kidney dysfunction• Pregnancy and lactation
NURSING GUIDELINES
• Give the medication before meals• Instruct client to rise uo slowly• Avoid caffeine and alcohol• Monitor blood levels• Report presence of sore throat, jaundice,
weakness and fever