Psych Nursing Ppt 1

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 wellbeing.

• 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

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

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,

COMMON BEHAVIOURAL TERMS • DISTURBANCES in PERCEPTION – Illusion – Hallucination • Auditory • Visual • Tactile

DISTURBANCES IN THINKING and 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 • 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

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

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.

ANTIPSYCHOTICS/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

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

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 neurotransmitte r 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