Chapter 94 Psychiatric Nursing

Introduction Basic principles of mental health apply to the care of all clients, no matter what the setting. People with physical illnesses also develop emotional or psychiatric problems that interfere with or influence their recovery. A nurse must encourage clients to seek counseling for stress before it becomes a greater concern.

Mental Health A mentally healthy person is Responsible for his or her own behavior and able to manage his or her own activities of daily living Able to adjust to new situations and handle personal problems without severe discomfort Has intellectual insight into personal strengths and weaknesses, and able to accept weaknesses and use strengths positively Able to accept frustration and change without resorting to harmful behavior

Mental Illness Mental illness A difference in degree of behavior Affects all spheres of a person’s life May be influenced by, or may be a contributing cause of, substance abuse and other addictions Psychiatric disorders Can arise from external conditions, life stressors, metabolic changes, or brain disorders

Defense Mechanisms Suppression Repression Reaction-formation Rationalization Displacement Denial Projection Sublimation Intellectualization

Diagnosis Organic versus functional Psychometric or neuropsychiatric tests Neurologic tests

Psychiatric Diagnoses The Multiaxial System of Psychiatric Diagnoses Axis I: Clinical psychiatric syndromes Axis II: Personality disorders and mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning

Question Is the following statement true or false? Cultural factors influence beliefs regarding causation and treatment of disease.

Answer True Normal and abnormal behaviors often depend on one’s cultural perspective. Different cultures also have varying customs and beliefs related to such concepts as eye contact, personal space, or causation of illness.

Types Clinical diagnosis Acute or chronic In remission Prior history Mood disorders Major depressive episode (MDE) Dysthymia Bipolar disorder (BPD)

Personality Disorders Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent

Question What is the pattern of deviation in a client with personality disorder? a. Interpersonal functioning b. Psychomotor retardation c. Fatigue d. Appetite changes e. Preoccupation

Answer a. Interpersonal functioning In a client with personality disorder, there is a deviation in interpersonal functioning or the client’s relationship. Other deviations include cognition, affectivity, poor impulse control, and intrusive or bizarre behaviors.

Anxiety Disorders Panic attacks Phobias Obsessive-compulsive disorder (OCD) Obsession, compulsion Posttraumatic stress disorder (PTSD)

Factitious Disorders Ganser syndrome Munchhausen syndrome Munchhausen by proxy

Psychosis Schizophrenia Paranoid Disorganized Undifferentiated Residual Catatonic Other psychoses Brief psychotic disorder Psychotic disorder caused by a medical condition

Types of Hallucinations Auditory Visual Tactile (haptic) Gustatory Olfactory Command auditory hallucinations Those that instruct clients to do something, often to hurt themselves or others.

Question Is the following statement true or false? A client cannot have symptoms of more than one mental disorder simultaneously.

Answer False A person can have symptoms of several mental disorders simultaneously. For example, a person with depression may also have hallucinations. An individual’s diagnosis may change over time. Therefore, the nurse must learn to deal with various behaviors and not to classify people in terms of their original diagnosis.

Dual Diagnosis Two separate chronic conditions at the same time Mental illness and sexual addiction Anorexia and chemical dependency Mental illness combined with chemical dependency (MI/CD)

Psychiatrist, Nurse, and Team Members Other team members Psychiatric technicians, mental health workers, human service workers, psychologists, psychometrists, recreation therapists and music therapists, occupational therapists, vocational rehabilitation and veteran’s services, chaplains and social workers

Treatment Centers and Resources Community-based programs Partial hospitalization programs Emergency services The inpatient psychiatry unit

The Inpatient Psychiatry Unit Admission status Commitment Special circumstances Discharge planning Provisional discharge Payment for mental healthcare

Methods of Psychiatric Therapy Psychotherapy Individual psychotherapy, group psychotherapy Verbal and other therapies Electroconvulsive therapy Medication therapy Psychotropic drugs, antipsychotic (neuroleptic) drugs, antianxiety agents, mood stabilizers, antidepressants

Question Is the following statement true or false? A nurse should give a client attention for positive behaviors.

Answer True Giving attention to any person is a powerful modifier of his or her behavior. It is important to give attention for positive behaviors as much as is possible. Giving attention for negative behaviors reinforces the unwanted behavior.

Forms of Medications Used in Psychiatry Oral medications Transdermal patch Injections

Question Is the following statement true or false? A client who is prescribed MAOIs should avoid over-the- counter medications like cold and hay fever products.

Answer True These clients should also avoid over-the-counter (OTC) medications that contain sympathomimetic amines, as these could produce hypertensive crises when mixed with MAOIs. In addition, some herbal preparations can cause serious side effects if combined with MAOIs. (The exception to this restriction is the lowest dose of transdermal selegiline [Emsam].) Also, warn clients taking MAOIs against eating foods with a high tyramine content.

The Client in an Inpatient Setting The therapeutic environment Rights of the client, prevention of dehumanization, visitors, outings Security Restraints, client safety devices, seclusion Nursing care of the severely disturbed client Physical care, teaching life skills and recreation, building employment or occupational skills

Mental Health Nursing Skills Physical care Emotional support Other skills Socializing agent, teacher, support person Observation If a client escapes Nursing actions in specific behaviors

Nursing Actions in Specific Behaviors Suicidal Overactive Hypomanic or manic Highly disturbed Hostile or combative Delusions or hallucinations Confused or demented Withdrawn Depressed Overactive and underactive behavior Regressed

Nursing Process Data gathering priorities Nursing history Data collection Possible nursing diagnoses Planning Implementation Evaluation

End of Presentation