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⊗ "A state of well-being where a person can realize his or her own abilities to
cope with the normal stresses of life and work productively." (WHO)
⊗ Balance in person’s internal life and adaptation to reality. Criteria for Mental Disorder:
⊗ State of well-being in which a person is able to realize his potentials. ⊗ Dissatisfaction with:
one’s characteristics, abilities and accomplishments
Criteria for Mental Health: one’s place in the world
⊗ Self-awareness ⊗ Ineffective:
♦ Ability to: interpersonal relationship
recognize one’s thoughts feelings, asset potentials and weakness. coping or adaptation to the events in one’s life
experience genuine feelings as anger, happiness, resentment
leads to self-acceptance, self-understanding in order to understand
MENTAL ILLNESS
others
⊗ A state in which an individual shows deficit in functioning and is unable to
⊗ Autonomy: ability to function independently and function with others
maintain personal relationship.
⊗ Perceptive ability
⊗ State of imbalance characterized by a disturbance in a person’s thoughts,
Awareness of stimuli, reality orientation.
feelings and behavior
Orientation to: Time, Place, Person
⊗ Factors that increase the risk are: Crises, Abuses, Poverty
⊗ Integral capacity: Ability to harmonize psychic forces (id, ego, super ego).
⊗ Self-actuation
Ability to adopt to life changes, happy to work with others Historical View of Mental Illness
Satisfaction in every endeavor ⊗ In the past, mental illness has been viewed as:
Genuine cooperation Demonic possession
⊗ Mastery of one’s environment: Awareness of the changes around him Influence of ancestral spirits
Result of violating taboo or neglecting cultural, ritual, and spiritual
condemnation
MENTAL HYGIENE ⊗ Period of Enlightenment (1745-1886)
⊗ a science that deals with: Promotive, Preventive, Curative, Rehabilitative Lunatics were restrained in iron menacles
aspects of care. Mentally ill were exhibited as diversion and entertainment for the
public
Establishment of asylums
MENTAL DISORDER Opening of state hospitals for mentally ill.
⊗ A medically diagnosable illness which results in significant impairment of ⊗ Period of Scientific Study
one's cognitive, affective or relational abilities and is equivalent to mental Psychoanalysis by Sigmund Freud
illness.
⊗ Psychotropic Drugs (1950)
Use of chlorpromazine and imipramine
Mental illness is caused by chemical imbalance in the brain.
Elements:
Asking direct questions How does your wife feel about your
hospitalization?
(Channel)
(Context) Clarifying
Confronting or presenting
I'm not sure that I understand what you are
trying to say.
I see no bats flying in this room.
Therapeutic Communication: a way of interacting in a purposeful manner to reality
promote the client’s ability to express his thoughts and feelings openly. Encouraging comparison Has this ever happened before?
Encouraging description How do you feel when you take your
Essentials for a Therapeutic Communication: medication?
Problems:
⊗ Transference
the development of an emotional attitude towards the nurse
positive or negative
⊗ Counter transference – experienced by the nurse / therapist 3 Psychic Energies
Termination Phase
⊗ Evaluate the summary of progress
⊗ Reinforce change and strength of patient
⊗ Give rewards for the cooperation during interaction
⊗ Encourage expression of feelings about termination of the relationship
⊗ Terminate the relationship without giving promises
Stages:
Stage 6:
Period of Life Young Adult, 18 to 54 yrs., (Love)
Stage 3:
Psychosocial Crisis Intimacy vs. Isolation
Examples: Examples:
• Imipramine (Tofranil) • Amitriptyline (Elavil) • Fluoxetine (Prozac) • Paroxetine (Paxil)
• Celatopram (Celexa) • Fluvoxamine (Luvox)
Nursing Implications: • Sertraline (Zoloft)
⊗ Best given after meals
⊗ Effectivity: after 2-3 weeks
⊗ Check the BP, it causes hypotension
⊗ Check the heart rate, it causes cardiac arrythmias
⊗ Monitor I & O Nursing Implications:
⊗ Monitor for signs of increased IOP ⊗ Avoid the use of:
• diazepam
• Alcohol
MAO INHIBITORS • Tryptophan
Indication: refractory depression • Monitor PTT, PT
⊗ Never give to pregnant / lactating mothers.
Examples:
• Tranylcypromine (Parnate)
• Phenelzine (Nardil)
• Isocarboxazid (Marplan) PaN aM a ANTI-MANIC AGENT
Examples:
Nursing Implications: • Lithium Citrate (Cibalith – S) • Lithium Carbonate (Eskalith,
⊗ Best taken after meals Lithane, Lithobid)
⊗ Report headache; it indicates hypertensive crisis
⊗ Avoid tyramine containing foods like: Nursing implications:
• Avocado ⊗ Best taken after meals
• Banana ⊗ Increase intake of:
• Cheddar and aged cheese • fluids (3 L /day)
• Soysauce • sodium (3 gm/day)
• Preserved foods ⊗ Avoid activities that increase perspiration
⊗ Effectivity: 2-3 weeks ⊗ Never give to pregnant mothers
⊗ Monitor the BP ⊗ Effectivity: 10-14 days
STRESS
Eustress - positive stress
• A nonspecific response of the body to any demand made upon it. (Hans
Selye, 1936) Distress
• A state produced by a change in the environment that is perceived as • Negative stress
challenging, threatening or damaging to the person’s dynamic equilibrium.
• Damaging stressors which may result in various physical and emotional
(Smeltzer, 1992)
disorders such as: anxiety, frustration, insecurity, aimlessness
Adaptation
CRISIS AND CRISIS INTERVENTION
• A constant ongoing process that occurs along time continuum, beginning • A situation that occurs when an individual's habitual coping ability becomes
with birth and ending with death. (Smeltzer, 1992)
ineffective to meet the demands of a situation.
• A continuous process of seeking harmony in an environment. • As a serious interruption and disturbance of one's equilibrium or
homeostasis
Types of Adaptation: • Leads to potentially dangerous, self-destructive or socially unacceptable
behavior.
General Adaptation Syndrome (GAS)
• Involves the whole body in response to stress. Characteristics
• Compared to life process as it focuses on the “wear and tear of the body • Highly individualized
tissues. • Self-limiting: 4-6 weeks
• Person affected becomes passive and submissive
Phases:
• Alarm • Affects a person’s support system
Phases
• Denial
• Increased Tension Rape Trauma Syndrome (RTS)
• Disorganization • Refers to a group of signs and symptoms experienced by a victim in
• Attempts to reorganize reaction to rape
• Stage for full reorganization
Phases:
• Acute Phase – shock, numbness, disbelief
CRISIS INTERVENTION • Denial – refusal to discuss the event
• Major Goal: • Heightened Anxiety – fear, tension, nightmares
o Restore the maximum level of functioning (pre-crisis state) • Stage of Reorganization
o It is an active but temporary entry into the life situation of an individual
or a family during a period of stress.
o A way of entering into the situation to help them mobilize their resources Battered Wife Syndrome (BWS)
and to decrease the effect of stress. • A form of cyclic domestic violence
• Men: low self-esteem
Domestic Violence Requiring Crisis Intervention: • Women: Dependent personality disorder
RAPE
• Apathy
• Bruised or swollen genitalia; tears or bruising of rectum or vagina
• Unusual injuries for the child’s age and development
Child Abuse • Serious injuries (fractures, burns, lacerations)
• Is an act of omission of responsibility or commission in which intentional • Evidence of old injuries not reported
harm is inflicted on a child.
Republic Act 7610
Components of Omission: (Anti Child Abuse Law)
• Child abandonment – leaving the child physically • Required reporting of suspected cases
• Child neglect - lack of provision of those things which are necessary for the • Report cases to the nearest authorities within 48 hours
child's growth and development
Types of Commission:
Physical Abuse
• Is an intentional physical harm inflicted on a child by a parent or other Assessment, Planning and Nursing Actions for Crisis
person. • Primary concerns:
o Physical injuries
Emotional abuse - insult and undermining one's confidence o Alleviation of psychological trauma
• Nurse should display:
Sexual abuse - abuse in the form of sexual contact o Sensitivity
o Attitude (Nonjudgmental)
Characteristics of Abusive Parents: o Confidentiality
• They come from violent families o Respect
• They were also abused by their parents o Empathy
• They have inadequate parenting skills o Dignity
• They are socially isolated because they don't trust anyone • Evidences are important:
• They are emotionally immature o stained clothing
• Fantasy
o Conscious distortion of unconscious feelings or wishes
DEFENSE MECHANISM o A boy who is being bullied by his friends wished he had the power of
Wolverine.
• These are automatic and usually unconscious processes or act by the
individuals to: • Fixation
o reduce or cope anxiety or fear o An unhealthy mechanism which is an arrest of maturation at certain
o resolve emotional or mental conflict stages of development.
o protect one's self-esteem o A boy never overcame being fully reliant from his mother.
o protect one's sense of security
• Becomes pathologic when overused. • Introjection
• Used by both mentally healthy and mentally ill individuals o Symbolic assimilation or taking into oneself a love/hatred object.
Derived from the word "introject" which literally means to take into or
Common Defense Mechanisms Used: ingest.
• Compensation o Common to depressed clients.
o An attempt to overcome a real or imagined short coming, inferiority,
inabilities and weaknesses. • Identification
o A blind woman becomes proficient in playing piano. o An individual integrates certain aspects of someone else's personality
into one's own.
o A young school teacher adopts his former mentor's teaching style when
conducting class sessions.
• Conversion
o Emotional problems are converted to physical symptoms
o A student unprepared for a report suffered headache the day she is • Intellectualization
supposed to deliver her report. o An overuse of intellectual concepts by an individual to avoid expression
of feelings
• Denial o A man who was asked to share a memorable experience about his
o Failure to acknowledge an intolerable thought, feeling, experience or grandmother who died discussed the stages of death and dying by
reality Elizabeth Kubler Ross.
o A middle-aged man after being admitted to the CCU because of an AMI,
insists that he is in the hospital for just a diagnostic work-up. • Projection
o Attributing to others one's unconscious wishes/fear.
• Repression
o It is the involuntary or unconscious forgetting of an unpleasant ideas or
impulses.
o During the nurse-patient relationships, patients often unconsciously
avoid discussing those experiences producing anxiety which are
emotionally difficult to verbalize.
• Suppression
o Permits the individual to store away or consciously forget the
unpleasant, painful and unacceptable thoughts, desires, experiences
and impulses.
o "I'll think it about tomorrow", "I'd rather go now", "Can we change the
topic?"
o A boy walked out from the group and said "I have to go now", when he
was asked what was happened to their relationship with his girlfriend.