Nursing Care 101 » Psychiatric http://www.nursingcare101.com Fri, 16 Sep 2011 17:26:17 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Thought Process Disturbance http://www.nursingcare101.com/thought-process-disturbance http://www.nursingcare101.com/thought-process-disturbance#comments Tue, 24 Aug 2010 14:42:53 +0000 eajrn http://www.nursingcare101.com/?p=1767 Mental Status Exam is the basis of a thought process disturbance. One must observe for the general appearance of the client wherein the client’s attitude or behavior (posture, facial expression mannerisms, and personal hygiene) and the characteristics of speech and stream of thought (content of message, verbal communication, loudness, quality, logic, and level of coherence) are observed.

Types of Thought Process Disturbance

Looseness of Association

Topics have its connection but is without thought.

Flight of Ideas

There is a constant flow of speech but topics remain unrelated.

Ambivalence

Presence of two opposing forces.

Magical Thinking

Client believes he has magical powers.

Echolalia

Client repeats what is being said.

Echopraxia

copies or echoes what a person is doing.

Word Salad

Mixes words and phrases that do not have any meaning.

Clang Associations

Mixes word or phrases in a rhyme or have a similar sound.

Neologism

Inventing of new words.

Delusion

Client presents with false beliefs, delusions of grandeur, and delusions of persecution.

Concrete Association

Client presents to be a smart-aleck or a know-it-all.

Hallucination

Perception without any stimulation.

Illusion

Distortion of senses and occurs with a stimuli.]]> http://www.nursingcare101.com/thought-process-disturbance/feed 0 Defense Mechanism http://www.nursingcare101.com/defense-mechanism http://www.nursingcare101.com/defense-mechanism#comments Tue, 24 Aug 2010 13:24:22 +0000 eajrn http://www.nursingcare101.com/?p=1760 Defense mechanism otherwise known as Ego defense mechanism or Coping mechanism are unconscious psychological strategies employed by different entities to cope with reality and to maintain self-image. It is an unconscious protective barrier to manage one’s instinct.

Purposes of Defense Mechanism

  1. Self-security protection
  2. Anxiety reduction
  3. Mental conflict resolution
  4. Self-esteem protection

Types of Defense Mechanism

Repression

It is the unconscious forgetting of a traumatic event. Repression is involuntary, automatic, and submerging of the painful experience.

Suppression

It is the conscious forgetting of a traumatic event. Suppression is also used in the intentional exclusion of forbidden ideas. It can also be viewed as avoidance.

Insulation

Insulation is withdrawing passively and becoming inaccessible to avoid further threatening situations.

Reaction Formation

Reaction formation is doing the opposite of what is intended. One assumes an attitude or behavior that one consciously regrets.

Rationalization

It attempts to justify or modify the unacceptable needs. A person mostly often uses “because”.

Fantasy

Gratification through imaginary achievements and wishful thinking.

Sublimation

It is the diversion of unacceptable needs or feelings into socially acceptable behavior.

Undoing

Undoing is an actual or symbolic attempt to erase previous experiences.

Regression

It is when one is returning to an earlier development stage to express an impulse to deal with anxiety.

Compensation

It is an attempt to make up or to accept deficiencies.

Denial

Denial is blocking out or disowning of painful thoughts or experiences.

Substitution

Substitution is the replacement of a valued unacceptable object with an object that is more acceptable to the ego.

Identification

Identification attempts to pattern or resemble a personality or trait of an admired person.

Projection

It is transferring one’s internal feelings, thoughts, and behavior acceptable by justifying the behavior.

Intellectualization

It is the overuse of intellectual concepts to avoid the real expression of feelings.

Conversion

Conversion is the transforming of an emotional problem into physical symptoms.

Isolation

Isolation is when a person blocks feelings associated with an unpleasant experience.

Displacement

One’s feelings for person A is directed to person B who is less threatening, hence satisfying an impulse with a substitute object.

Introjection

Is where the individual incorporates the trait of another into oneself.

Dissociation

It is the blocking-off of an anxiety provoking event or period of time.

Symbolization

Symbolization is the use of an idea or object to represent another actual event or object.

Fixation

One never advancing to the next level of emotional development and organization ]]> http://www.nursingcare101.com/defense-mechanism/feed 0 Schizophrenia http://www.nursingcare101.com/schizophrenia http://www.nursingcare101.com/schizophrenia#comments Mon, 22 Mar 2010 05:57:32 +0000 eajrn http://www.nursingcare101.com/?p=1399 Schizophrenia is a group of mental disorders characterized by psychotic features, the inability to trust others, and unordered thought processes. The client also withdraws from reality, shows regressive behavior, has ineffective communication and a reversely impaired inter-personal relationship. Typical onset occurs in early adulthood with diagnosis based on observation and the patient's experiences.

]]> Schizophrenia is a group of mental disorders characterized by psychotic features, the inability to trust others, and unordered thought processes. The client also withdraws from reality, shows regressive behavior, has ineffective communication and a reversely impaired inter-personal relationship. Typical onset occurs in early adulthood with diagnosis based on observation and the patient’s experiences.

Types of Schizophrenia

  1. Disorganized or Hebephrenic Schizophrenia. There is severe and pronounced mental incapacity. The client manifests a flat affect and peculiar behavior. Social withdrawal and delusions are common.
  2. Catatonic Schizophrenia. The client has catatonic stupor wherein he manifests waxy flexibility, withdrawal, distorted reality, and ambivalence.
  3. Paranoid Schizophrenia. The patient undergoes delusions as compensatory mechanism and hallucinations.
  4. Undifferentiated Schizophrenia. There are mixed symptoms. The client also manifests a flat affect. Factors: severe emotional problem, chronic insecurity or a total failure in inter-personal relationships, difficulty in restoration of integrity and personality.

Delusion

Delusions are false beliefs considered to be true even though there is sufficient evidence on the contrary. The client also believes the certain events, situations, or actions are directly related to self. Types of Delusions:
  • Delusions of Grandeur. The client believes that one is powerful and an important person or being.
  • Delusions of Persecution. The client believes that he is being singled-out for harm by others.
  • Delusions of Jealousy. The client believes that he’s partner is going out with another person.

Assessment for Schizophrenia

  1. 4 A’s
    • Affect. If client manifests flat or blunted it is considered inappropriate.
    • Associative looseness. The client’s verbalization is disorganized.
    • Ambivalence. The client has two conflicting emotions.
    • Autism. Thoughts on self, extreme withdrawal, and the inability to relate to the outside world.
  2. Ability to perform Activities of Daily Living (ADLs). Clients with Schizophrenia have difficulties in performing self-care activities. Also, client have nutritional deficit.
  3. Aggression
  4. Suicidal Potential
  5. Any changes in thoughts or feelings.
  6. Disturbances in inter-personal relationships.

Nursing Diagnosis for Clients with Schizophrenia

  1. Anxiety related to disturbed thought processes.
  2. Impaired verbal communication related to inappropriate use of words.
  3. Ineffective family coping related to ambivalent family relationships.
  4. Sensory perceptual alterations related to misinterpretation of stimuli.

Nursing Care for Clients with Schizophrenia

  • Encourage the client to follow drug regimen.
  • Observe adverse drug reactions especially major tranquilizers.
  • Encourage the development of interpersonal relationships.
  • Encourage the client towards presentation to reality.
  • Accept the level of functioning.
  • Respect the patient as a human being with dignity and worth.
]]> http://www.nursingcare101.com/schizophrenia/feed 0 Conditions Requiring Crisis Intervention http://www.nursingcare101.com/conditions-requiring-crisis-intervention http://www.nursingcare101.com/conditions-requiring-crisis-intervention#comments Tue, 25 Aug 2009 01:00:15 +0000 eajrn http://www.nursingcare101.com/?p=874 Crisis intervention is needed to be done when a client is experiencing crisis in his life. This enables the client to work with the crisis, develop a way to overcome the crisis, and obtain the optimum level of functioning. This also allows the client to cope and still live as normally as he or she could while experiencing or after experiencing crisis in his life. There are several states that require crisis intervention but in this article, we would only discuss the two most important.

]]> Crisis intervention is needed to be done when a client is experiencing crisis in his life. This enables the client to work with the crisis, develop a way to overcome the crisis, and obtain the optimum level of functioning. This also allows the client to cope and still live as normally as he or she could while experiencing or after experiencing crisis in his life. There are several states that require crisis intervention but in this article, we would only discuss the two most important.

Rape Trauma Syndrome (RTS)

Rape is the insertion of the penis or any object into the vagina, anus, or mouth without the consent of the other. There is also a sign of aggression, hostility, and violence.

Elements of Rape

  1. Use of threat or force
  2. Lack of consent of the victim
  3. Actual penetration of the penis or any object into the vagina, anus, or mouth.

Types of Rape

  1. Power Rape. This usually done to prove one’s masculinity.
  2. Anger Rape. This is done for retaliation of revenge.
  3. Sadistic Rape. This is done to express erotic feelings.

Rape Trauma Syndrome refers to a group of signs and symptoms experienced by the victim in reaction to rape.

Phases of Rape Trauma Syndrome

  1. Acute phase. The client experiences shock, numbness, and disbelief.
  2. Denial. The victim refuses to talk and is constantly crying.
  3. Heightened anxiety. The client experiences fear, tension, and nightmares.
  4. Stage of Reorganization. The victim’s life slowly normalizes.

Nursing Diagnosis for Rape Trauma Syndrome

Ineffective Individual Coping (Priority nursing diagnosis)

Interventions:
  1. Express or verbalize feelings towards rape.
  2. Preserve the evidence.

Battered Wife Syndrome (BWS)

Battered Wife Syndrome is a cycle of domestic violence characterized by wife-beating by the husband. The beater usually experiences humiliation and aggression which he then manifests towards his wife. The most common trait of abusive men is low self-esteem while, the most common trait of abused women is dependency.

Characteristics of Abusive Husbands

  • They came from violent families
  • Are immature, dependent, and non-assertive
  • Has strong feelings of inadequacy or insecurity

Phases of Battery

  1. Tension-Building Phase. Minor battering incident occurs.
  2. Acute Battering Incident. Serious form of battering happens.
  3. Honeymoon Stage or Aftermath. The husband suddenly becomes attending and loving. The wife, having a dependent attitude, accepts this and stays with her husband. The cycle thus continues and goes back to the first phase.

Nursing Intervention for Battered Wife Syndrome

Provision of shelter should be given to the victim and counseling.

]]> http://www.nursingcare101.com/conditions-requiring-crisis-intervention/feed 0 Crisis and Crisis Intervention http://www.nursingcare101.com/crisis-and-crisis-intervention http://www.nursingcare101.com/crisis-and-crisis-intervention#comments Mon, 24 Aug 2009 01:00:46 +0000 eajrn http://www.nursingcare101.com/?p=870 Crisis is a situation that occurs when the individual's patterns of functioning is affected. The habitual coping ability is affected. Crisis intervention on the other hand is a way of entering into the life situation of the individual, family, or community. This is done to attain optimum level of functioning.

]]> Crisis is a situation that occurs when the individual’s patterns of functioning is affected. The habitual coping ability is affected. Crisis intervention on the other hand is a way of entering into the life situation of the individual, family, or community. This is done to attain optimum level of functioning.

Characteristics of Crisis

  1. Highly individualized
  2. Last from 4-6 weeks
  3. Passive-Submissive
  4. Affects the support system

Types of Crisis

  1. Maturational Crisis (Developmental Crisis)

    This are expected and predictable which are internally motivated. I.E. Pregnancy, Marriage, Parenthood

  2. Situational Crisis (Accidental)

    This are unexpected and unpredictable which are externally motivated. I.E. Car accidents

  3. Social Crisis

    Natural occurrences. I.E. Earthquake, Tidal waves

Stages of Crisis Intervention

  1. Denial. It is the initial reaction.
  2. Increased tension. Presence of crisis triggers it.
  3. Disorganization. The person is pre-occupied with crisis situation.
  4. Re-organization. The person goes back to his normal life or activities.
]]> http://www.nursingcare101.com/crisis-and-crisis-intervention/feed 0 Conceptual Framework of Psychiatric Care http://www.nursingcare101.com/conceptual-framework-of-psychiatric-care http://www.nursingcare101.com/conceptual-framework-of-psychiatric-care#comments Sat, 22 Aug 2009 01:00:08 +0000 eajrn http://www.nursingcare101.com/?p=853 Psychiatric care should be systematic and the approach to the client should be rational.

]]> Psychiatric care should be systematic and the approach to the client should be rational.

  1. Psychodynamic Framework

    This focuses on the Intrapsychic process. This includes the psychosexual development, developmental stages of man, and interpersonal.

  2. Personality Dynamics

    This includes the components of personality (Id, Ego, and Superego), the topography of the mind (Conscious, Unconscious, and Subconscious), and defense mechanisms.

  3. Behavioral Framework

    Focus on the learned behavior. Has rewards and punishments and is affected by the environment.

  4. Humanistic Framework (Existential Framework)

    Focuses on the human experiences. “Here and now.”

  5. Interpersonal Framework

    Focus on the communication and relationship.

  6. Pharmacological or Biomedical Framework

    Focus on disease process, psychotherapy, and treatment.

Topography of Mind

  1. Conscious

    Awake, thinking being. Contains the ego, self, and past experiences that can be easily recalled without any effort.

  2. Subconscious (Pre Conscious)

    The ideas, feelings, reactions are stored but can easily be forgotten. It is manifested in the “tip of the tongue” experience wherein a person recalls something but could not process what it is. This is considered the watchman of experience.

  3. Unconscious

    Is the largest part of the mind that exerts no effort. Is the store house of memories, feelings or ideas. It is expressed by jokes, lapses of memories, and dreams.

Components of Personality (Levels of Personality)

  1. Id

    Is the pleasure principle. Is developed during the infancy stage. Is the impulsive part. If a person is Id dominant, he could be Manic, Antisocial, or Narcissistic. If a person is also Id dominant it needs the Superego to counterbalance it.

  2. Ego

    Is the self or I. Pertains to the real principle. If ego is affected an impaired perception can occur. The ego is known as the integrator of personality.

  3. Superego

    The super ego is the conscience or is the morality of a person. If The superego is dominant, the Id is needed. A client with Superego dominance can be Obsessive, Compulsive, or Anorexic.
]]> http://www.nursingcare101.com/conceptual-framework-of-psychiatric-care/feed 0 Nurse-Patient Relationship http://www.nursingcare101.com/nurse-patient-relationship http://www.nursingcare101.com/nurse-patient-relationship#comments Thu, 20 Aug 2009 10:47:33 +0000 eajrn http://www.nursingcare101.com/?p=867 A good, working relationship is essential in any setting, in any type of work, in any field, and in any profession. It is most especially an important aspect in nursing because it allows the nurse to do to his job more efficiently and it allows the client to further understand what he is going through and would allow him to recover much better.

There are two types of relationship and these are the Therapeutic relationship and Social relationship. Therapeutic relationship is a personal relationship and meets the emotional needs of the other, this is where your client becomes the focus. Social relationship attends to the needs of both parties, in this example the nurse and the client are both considered.

]]> A good, working relationship is essential in any setting, in any type of work, in any field, and in any profession. It is most especially an important aspect in nursing because it allows the nurse to do to his job more efficiently and it allows the client to further understand what he is going through and would allow him to recover much better.

There are two types of relationship and these are the Therapeutic relationship and Social relationship. Therapeutic relationship is a personal relationship and meets the emotional needs of the other, this is where your client becomes the focus. Social relationship attends to the needs of both parties, in this example the nurse and the client are both considered.

Phases of Establishing a Relationship

  1. Orientation Phase

    This is where introduction and role definition is done. The nurse develops trust and rapport between him and the client. The nurse clarifies therapeutic parameters. This includes brief and frequent interactions and the establishment of discharge plan is made. Admission assessment of the client should be done within 24 hours.

  2. Working Phase

    This phase promotes problem solving skills. The nurse teaches new coping strategies. Evaluation and redefining the problems occurs in this phase.

  3. Termination Phase

    Solidification of separation and review of accomplishments is done. This is where transfer of dependency needs occurs. Final and ongoing maintenance of therapeutic parameters occurs.
]]> http://www.nursingcare101.com/nurse-patient-relationship/feed 0 Introduction to Psychiatric Nursing http://www.nursingcare101.com/introduction-to-psychiatric-nursing http://www.nursingcare101.com/introduction-to-psychiatric-nursing#comments Tue, 11 Aug 2009 04:06:12 +0000 eajrn http://www.nursingcare101.com/?p=766 Mental health affects the individual, family, and community to respond adaptively to internal and external stressors. Psychiatric Nursing is more on the internal process and the interpersonal process between the professional nurse and the patient to promote and maintain the optimum level of functioning. Psychiatric Mental Health Nursing focuses on the external, internal, and interpersonal process.

]]> Mental health affects the individual, family, and community to respond adaptively to internal and external stressors. Psychiatric Nursing is more on the internal process and the interpersonal process between the professional nurse and the patient to promote and maintain the optimum level of functioning. Psychiatric Mental Health Nursing focuses on the external, internal, and interpersonal process.

Eight Human Responses

  • Activity
  • Cognitive or cognition
  • Environment
  • Emotions
  • Interpersonal
  • Intrapersonal
  • Perception
  • Physiological

Population at Risk for Metal Illness

  • Familial predisposition
  • Poor access to health care
  • Poverty or poor families
  • Misusing substances
  • Undergoing lifestyle changes
  • Violence or victims of violence
  • Elderly persons

Levels of Care in Psychiatric Nursing

  1. Primary Prevention. Alternating causative factors that hinder the development of mental illness. Provision of client and family teaching, stress reduction, and psychosocial support.
  2. Secondary Prevention. Reducing the effects of mental illness. Provision of screenings like psychiatric evaluation, crisis intervention, suicide prevention, and short-term counseling.
  3. Tertiary Prevention. Minimizing the long-term residual effects. Provision of rehabilitation program, vocational training, and after care support.

Qualities of a Psychiatric Nurse

  • Views from the patient as a holistic human being.
  • Focuses on the strengths.
  • Accepts the client as a unique human being.
  • Focuses on the therapeutic relationship.
  • Explores the client’s behavior.
  • Views the client with a non-judgmental attitude.
  • Applies an effective adaptation.
  • Competent.

Attributes of Mental Health

  • Accepts strengths and limitations.
  • Perceives the reality accurately.
  • Mastery of environment.
  • Independent thinking.
  • Unifying integrated outlook in life.
]]> http://www.nursingcare101.com/introduction-to-psychiatric-nursing/feed 0 Therapeutic and Non-Therapeutic Communication in Nursing http://www.nursingcare101.com/therapeutic-and-non-therapeutic-communication-in-nursing http://www.nursingcare101.com/therapeutic-and-non-therapeutic-communication-in-nursing#comments Mon, 03 Aug 2009 14:17:01 +0000 eajrn http://www.nursingcare101.com/?p=612 Communication is the giving and receiving of information via talk, gestures, and writing. The purpose of communication is to persuade, inquire, and entertain. Communicating with clients is part of the nurses' job to enable the client to verbalize his feelings towards his illness and to help the client cope.

]]> Communication is the giving and receiving of information via talk, gestures, and writing. The purpose of communication is to persuade, inquire, and entertain. Communicating with clients is part of the nurses’ job to enable the client to verbalize his feelings towards his illness and to help the client cope.

Therapeutic Communication

Therapeutic Communication helps build the nurse-patient relationship. It is the process by which the nurse consciously utilizes the principles of communication in a goal-directed framework.

Focus of Therapeutic Communication

  1. Here and now.
  2. What. (Nurses should not focus on why)
  3. Orientation and presentation of reality.
  4. Description rather than judging.
  5. Maintenance of biological integrity.
  6. Actual client’s behavior.
  7. Nursing interventions.
  8. Sharing of information.

Types of Therapeutic Communication

  1. Broad openings. This individualizes the conversation. And focuses the attention of the client.
  2. Reflecting. The nurse verbalizes what is being stated or implied.
  3. Paraphrasing. The nurse restates the content of the message.
  4. Verbalizing observation. Commenting on what the nurse perceives.
  5. Encouraging verbalization. Promoting the client to continue verbalization. I.E. “Go on..”, “Tell me more..”
  6. General leads. Freedom of response.
  7. Clarifying. Understanding of what is unclear.
  8. Validating. Checking the perception of the client.
  9. Focusing. The nurse directs the flow of interaction.
  10. Summarizing. Putting together all the salient points.
  11. Offering self. Provides comfort by presence of nurse.
  12. Using silence. Allows the client to think about self.
  13. Suggesting collaboration. Offering to work with your client towards a goal
  14. Placing event in time or sequence. Time directed element.

Non-therapeutic Communication

Non-therapeutic communication displays a lack interest to the client and is demonstrated through a closed posture, restlessness, and inattentiveness.

Types of Non-therapeutic Communication

  1. False reassurance
  2. Giving advice
  3. Rejecting
  4. Probing
  5. Loading. (Overloading or Underloading.
]]> http://www.nursingcare101.com/therapeutic-and-non-therapeutic-communication-in-nursing/feed 0 Psychosexual Alterations http://www.nursingcare101.com/psychosexual-alterations http://www.nursingcare101.com/psychosexual-alterations#comments Mon, 27 Jul 2009 07:46:39 +0000 eajrn http://www.nursingcare101.com/?p=456 Sexuality is one's sense of being a sexual individual and includes one's looks, behaviors, and how the person relates to others. Sexuality generates great emotional and psychological responses that affects humans on a daily basis. Some theorists like Sigmund Freud even relate sexuality as the central source of human personality.

]]> Sexuality is one’s sense of being a sexual individual and includes one’s looks, behaviors, and how the person relates to others. Sexuality generates great emotional and psychological responses that affects humans on a daily basis. Some theorists like Sigmund Freud even relate sexuality as the central source of human personality.

Sexual Expression

Bisexuality

The client has sexual attraction to and sexual activity with both male and female sexes.

Heterosexuality

It is the Male-Female relationship.

Homosexuality

There is sexual attraction to a member of the same sex (Male-Male, Female-Female).

Transvestism

An obsession with wearing the clothing of the opposite sex is present.

Alterations in Sexual Behavior

  • Frotteurism. The client expereiences an intense sexual arousal and/or desire when rubbing against a nonconsenting person.
  • Voyeurism. Sexual gratification is obtained through observing others disrobing or engaging in sexual activity.
  • Exhibitionism. The person’s sexual urges and fantasies is manifested by exposure of genitals to strangers.
  • Fetishism. The use of nonliving objects is done for sexual gratification.
  • Transsexualism. There is a feeling that one’s ex in inappropriate and desires to acquire sexual characteristics of the opposite sex.
  • Zoophilia. Intense sexual arousal or desire is observed when there is sexual contact with animals.
  • Sexual Masochism. Sexual gratifications is obtained by receiving pain.
  • Sexual Sadism. Sexual gratification is obtained by inflicting pain.
  • Pedophilia. Desiring sexual activity with a child under the age of 13.

Nursing Interventions for Psychosocial Alterations

  • The nurse should assess sexual history and precipitating event for sexual disorder.
  • The client should be encouraged to explore personal beliefs.
  • There should be a nonjudgmental attitude.
  • Provide supportive psychotherapy.
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