1. NURSING
WHO IS CRAZY NOW
GILBERT T. SALACUP,RN,MSN
“ Sir G”

2. Reference
MSN
GILBERT
BOOK
Sheila L. Videbeck
T. SALACUP
Alice M. Stain
NET:
www.psychcenter.com

3. Psychiatric Nursing
MSN
GILBERT
-branch of nursing care with aim of assisting
1. Individual 2. Family 3. Community
To:
P - revent mental illness
T. SALACUP
A –ttain and maintain mental health
Co – pe with mental illness
Fi – nding meaning in mental illness
experience and suffering

4. Self Awareness
MSN
GILBERT
The process of knowing ones own
R- esponses in different situations
A- ttitudes
Per - sonality,
T. SALACUP
Pre - conceptions
S- trengths,
Wea - knesses,
P - rinciple,
Be - liefs, s
Fee - lings,

5. MSN
GILBERT
Significance
1. Self awareness differs from self - understand
2. The major therapeutic tool of the n is nurse is the
use of self
Goal of Self awareness
T. SALACUP
To decrease the size of blind and
private quadrants
2 Major Advantage in working
toward goal
1. Increase in self – awareness and self – disclosure
2. Gain more control over own behavior

6. GILBERT T. SALACUP
MSN

7. Therapeutic Nurse-
MSN
GILBERT
1. Pre – Interaction
 B-egin before the nurse first contact with the PT
 S-elf awareness
Therapeutic Task of the Nurse
T. SALACUP
1.Self Exploration feelings, fears, fantasies
2. Gathering Data about Pt available information
3. Planning for the 1st interaction with the patient

8. 2. Orientation Stage
MSN
GILBERT
- A - ssessment and diagnosis phase
- D-evelopment of mutually acceptable
contact
Therapeutic Task of the Nurse
T. SALACUP
 Rapport Trust is built by demonstrating
acceptance and non-judgmental attitude.
 Identify Patients Problem
 Mutually defined Goals with patients
 Formulate Nursing Diagnosis set priorities
 Explore the patients feelings thoughts and
actions encourage to share it with the nurse

9. 3. Working Phase
MSN
GILBERT
- I - dentification and declaration of
patients problems
- R - esistance observe
T. SALACUP
Therapeutic Task of the Nurse
 Explore relevant stressor
 Listening and Observing – tools use in this phase
 Realize theirs somebody appears interested to him who is
warm and accepting can relate
 Develop a plan of action and implement then evaluate
 Assess client readiness for independent functioning
 Assist patient change maladaptive behavior

10. MSN
GILBERT
4. Termination Phase
T - ermination has been started in initial phase
A - ssumed that Pt is already with more understanding
Therapeutic Task of the Nurse
T. SALACUP
- Review progress of the therapy and attainment
of goal
- Explore feelings of rejection, loss sadness, anger
- Space contacts dec. time, visits, each contact
- Established more relax environment
- Privide necesarry referals

11. MSN
GILBERT
Sigmund Freud
 Father of Psychoanalysis
 Structure of Personality (Id, Ego, Superego)
ID
T. SALACUP
PLEASURABLE PRINCIPLE Dominant
ID
 Pain Avoidance I Nar -
cisistic
 Puro “I”/ ako Ma – nia
tisocial
E An - S
want to Eat
Want to drink

12. MSN
GILBERT
EGO
REALITY PRINCIPLE
T. SALACUP
Impaired Reality
Schizophrenia
Impaired
E

13. MSN
GILBERT
SUPER EGO
CONSCIENCE PRINCIPLE
houldn't be
T. SALACUP
ense the voice of God
S
DOMINANT SUPER EGO
Obsessive – compulsive
Anorexia Nervosa E I

14. Therapeutic Communication
MSN
GILBERT
Effective Communication:
A - daptive
 N - eutral responses
 A – ppropriate
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 R - eflect, restate, rephrase verbalization of patient
 S - tate behaviors observed
 Fo - cus on feelings
 Si - mple
 Co - ncise
 C - redible
 O - pen ended questions

15. Therapeutic relationship
MSN
GILBERT
Relationship between health care professional and client
Purpose : assisting the client to solve his problems.
Components of a Therapeutic Relationship
1. TRUST
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2. GENUINE INTEREST - he or she should be open,
honest and display a congruent behavior
3. ACCEPTANCE - Situation: A client tries to kiss the nurse.
 Inappropriate response: What the hell are you doing?!
I’m leaving maybe I’ll see you tomorrow.
 Appropriate response: Adam, do not kiss me. We are
working on your relationship with your girlfriend and
that does not require you to kiss me. Now let us
continue.

16. 4. EMPATHY
MSN
GILBERT
It is simply being able to put oneself in the client’s shoes.
However, it does not require that the nurse should
have the same or exact experiences as of the patient.
Client’s statement:
 “I am so sad today. I just got the news that my father
T. SALACUP
died yesterday. I should have been there, I feel so
helpless.”
 Nurse’s Sympathetic Response:
 “I know how depressing that situation is. My father
also died a month ago and until now I feel so sad every
time I remember that incident. I know how bad that
makes you feel.”
 Nurse’s Empathetic Response:
 “I see you are sad. How can I help you?

17. 5. POSITIVE REGARD
MSN
GILBERT
unconditional and nonjudgmental attitude where
the nurse appreciates the client.
 Calling the client by name
 Spending time with the client
T. SALACUP
 Listening to the client
 Responding to the client openly
 Considering the client’s ideas and preferences when
planning care
6. SELF-AWARENESS

18. MSN
GILBERT
THERAPEUTIC USE OF SELF
Therapeutic Technique
1. Offering Self
making self-available and showing interest and concern.
“I will walk with you”
T. SALACUP
2. Active listening
paying close attention to what the patient is saying by
observing both verbal and non-verbal cues.
Maintaining eye contact and making verbal remarks to
clarify and encourage further communication.
3. Exploring
“Tell me more about your son”
4. Giving broad openings
What do you want to talk about today?

19. 5. Silence - Planned absence of verbal remarks
MSN
GILBERT
6. Stating the observed
verbalizing what is observed in the patient to, for
validation and to encourage discussion
“You sound angry”
7. Encouraging comparisons
T. SALACUP
describe similarities and diff.feelings,behaviors,& events.
· “Can you tell me what makes you more comfortable,
working by yourself or working as a member of a
team?”
8. Identifying themes
asking to identify recurring thoughts, feelings, and
behaviors.
“When do you always feel the need to check the locks and
doors?”

20. 9. Summarizing
MSN
GILBERT
making appropriate conclusions.
“During this meeting, we discussed about what you will
do when you feel the urge to hurt your self again and
this include…”
10. Placing the event in time or sequence
T. SALACUP
asking for relationship among events.
“When do you begin to experience this ticks? Before or
after you entered grade school?”
11. Voicing doubt
uncertainty about the reality of statements, perceptions
and conclusions. “I find it hard to believe…”
12. Encouraging descriptions of perceptions
feelings, perceptions and views of their situations
“What are these voices telling you to do?”

21. 13. Presenting reality or confronting
MSN
GILBERT
stating what is real and is not without arguing
“I know you hear these voices but I do not hear them”.
“I am G, your nurse,and this is a hospital and not a beach
resort.
14. Seeking clarification
T. SALACUP
asking patient to restate, elaborate, or give examples of
ideas or feelings to seek clarification of what is unclear.
“I am not familiar with your work, can you describe it
further for me”.
15. Verbalizing the implied
rephrasing patient’s words to highlight an underlying
message to clarify statements.
Patient: I wont be bothering you anymore soon.
Nurse: Are you thinking of killing yourself?

22. 16. Reflecting
MSN
GILBERT
throwing back the patient’s statement in a form of
question
Patient: I think I should leave now.
Nurse: Do you think you should leave now?
17. Restating
T. SALACUP
repeating the exact words of patients
Patient: I can’t sleep. I stay awake all night.
Nurse: You can’t sleep at night?
18. General leads
using neutral expressions to encourage patients to
continue talking.
“Go on…”
“You were saying…”

23. 19. Asking question
MSN
GILBERT
using open-ended questions to achieve relevance and
depth in discussion.
“How did you feel when the doctor told you that you are
ready for discharge soon?”
20. Empathy
T. SALACUP
21. Focusing
pursuing a topic until its meaning or importance is clear.
“Let us talk more about your best friend in college”
“You were saying…”
22. Interpreting - providing a view of the meaning or
importance of something.
Patient: I always take this towel wherever I go.
Nurse: That towel must always be with you.

24. 23. Encouraging evaluation
MSN
GILBERT
asking for patients views of the meaning or importance of
something.
“What do you think led the court to commit you here?”
“Can you tell me the reasons you don’t want to be
discharged?
T. SALACUP
24. Suggesting collaboration
offering to help patients solve problems.
“Perhaps you can discuss this with your children so they
will know how you feel and what you want”.
25. Encouraging goal setting
asking patient to decide on the type of change needed.
“What do you think about the things you have to change
in your self?”

25. 26. Encouraging formulation of a plan of action
MSN
GILBERT
probing for step by step actions that will be needed.
“If you decide to leave home when your husband beat
you again what will you do next?”
27. Encouraging decisions
T. SALACUP
asking patients to make a choice among options.
“Given all these choices, what would you prefer to do.
28. Encouraging consideration of options
asking patients to consider the pros and cons of
possible options.
“Have you thought of the possible effects of your
decision to you and your family?”

26. 29. Giving information - providing information will help
MSN
GILBERT
patients make better choices.
“Nobody deserves to be beaten and there are people who
can help and places to go when you do not feel safe at
home anymore”.
30. Limit setting
T. SALACUP
discouraging nonproductive feelings and behaviors, and
encouraging productive ones.
“Please stop now. If you don’t, I will ask you to leave the
group and go to your room.
31. Supportive confrontation
acknowledging the difficulty in changing, but pushing for
action.
“I understand. You feel rejected when your children sent
you here but if you look at this way…”

27. 32. Role playing - both the nurse and patient play
MSN
GILBERT
particular role.
“I’ll play your mother, tell me exactly what would you say
when we meet on Sunday”.
33. Rehearsing
asking the patient for a verbal description of what will be
T. SALACUP
said or done in a particular situation.
“Supposing you meet these people again, how would you
respond to them when they ask you to join them for a
drink?”.
34. Feedback
pointing out specific behaviors and giving impressions of
reactions.
“I see you combed your hair today”.

28. 35. Encouraging evaluation
MSN
GILBERT
asking patients to evaluate their actions and
their outcomes.
“What did you feel after participating in the
group therapy?”.
T. SALACUP
36. Reinforcement
giving feedback on positive behaviors.
“Everyone was able to give their options when we
talked one by one and each of waited patiently
for our turn to speak”.

29. Non-therapeutic Technique
MSN
GILBERT
Avoid pitfalls:
1. Giving advise
2. Talking about your self
T. SALACUP
3. Telling client is wrong
4. Entering into hallucinations and delusions of client
5. False reassurance
6. Cliché
7. Giving approval
8. Asking WHY?
9. Changing subject
10.Defending doctors and other health team members.

30. Non-therapeutic Technique
MSN
GILBERT
1. Overloading
talking rapidly, changing subjects too often, and asking
for more information than can be absorbed at one time.
“What’s your name? I see you like sports. Where do
you live?”
T. SALACUP
2. Value Judgments
giving one’s own opinion, evaluating, moralizing or
implying one’s values by using words such as “nice”,
“bad”, “right”, “wrong”, “should” and “ought”.
“You shouldn’t do that, its wrong”.
3. Incongruence
sending verbal and non-verbal messages that contradict
one another.
The nurse tells the patient “I’d like to spend time with
you” and then walks away.

31. 4. Under loading
MSN
GILBERT
remaining silent and unresponsive, not picking up cues,
and failing to give feedback.
The patient ask the nurse, simply walks away.
5. False reassurance/ agreement
Using cliché to reassure client. “It’s going to be alright”.
T. SALACUP
6. Invalidation
Ignoring or denying another’s presence, thought’s or feelings.
Client: How are you?
Nurse responds: I can’t talk now. I’m too busy.
7. Focusing on self
responding in a way that focuses attention to the nurse
instead of the client.
“This sunshine is good for my roses. I have beautiful rose
garden”.

32. 8. Changing the subject
MSN
GILBERT
introducing new topic inappropriately,
The client is crying, when the nurse asks “How many
children do you have?”
9. Giving advice
giving opinions or making decisions for the client,
T. SALACUP
“If I were you… Or it would be better if you do it this
way…”
10. Internal validation
making an assumption about the meaning of someone
else’s behavior that is not validated by the other person
(jumping into conclusion).
The nurse sees a suicidal clients smiling and tells
another nurse the patient is in good mood.

33. Other ineffective behaviors and responses:
MSN
GILBERT
1. Defending – Your doctor is very good.
2. Requesting an explanation – Why did you do that?
3. Reflecting – You are not suppose to talk like that!
4. Literal responses – If you feel empty then you should eat more.
5. Looking too busy.
T. SALACUP
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture - crossing arms on chest
11. Making false promises I’ll make sure to call you when you get home.
12. Ignoring the patient – I can’t talk to you right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do those things

34. DEFENSE
MECHANISMS

35. DISPLACEMENT • Transfer of feelings • Boss shouts at you, you
shout at your subordinate
MSN
GILBERT
to a less threatening • A patient yells at a
object rather than nurse after becoming
angry at his
the one who
mother for not
provoke it calling him.
DENIAL • Failure to acknowledge an • “I’m not an alcoholic”
T. SALACUP
unacceptable trait or • A woman newly
situation diagnosed with end-
stage-cancer says,
“I’ll be okay, it’s not
a big deal”.
DISSOCIATION • Psychological flight from self • “Sino ka, Sino ako?”
• A type of amnesia
Acting Out • Acting out refers to repeating Example: A husband
certain actions to ward off gets angry with his
anxiety without weighing the wife and starts staying
possible consequences of those at work later.
action.

36. INTROJECTION • Assume another person’s trait as • “ako din”
MSN
GILBERT
your own
• Not just you, me
too
SUPPRESSION • Conscious forgetting of an anxiety • Hindi ko alam yan
provoking concept
SUBLIMATION • Placing sexual energies toward a • may channel his
more productive endeavours
sex drive into his
sports or
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hobbies.
CONVERSION • Repressed angers put towards • Biglang mangingig
physical symptoms affecting
nervous system leading to sensory
numbness and motor paralysis
COMPENSATION • Overachievement in one area • Pilay pero magaling
to cover a defective part
kumanta
SUBSTITUTION • Replacing a difficult goal with a • Gusto ko .
more accessible one
Enchanted nalang.

37. UNDOING • Doing the opposite of • “ay pinatid kita, halika
punta kita sa clinic
what you have done
• A patient who says
due to guilt
something bad
• plastic
about a friend may
try to undo the
harm by saying nice
things about her or
by being nice to her
and apologizing.
IDENTIFICATION • Assume trait for personal, social, • Tulad nya
occupational role
• An adolescent girl
begins to dress and act
like her favorite pop
star.
PROJECTION • Attributing to others one’s • “hindi ako alcoholic,
acceptable trait
sila yon”
• Pasa load

38. RATIONALIZATION • Illogical reasoning for a • I drink because I don’t
socially unacceptable trait want to waste the beer in
• “sayang ang beer sa ref, kaya the ref
ko ininum”
• An individual states that
she didn’t win the race
because she hadn’t gotten a
good night’s sleep
REACTION FORMATION • doing the opposite of your • sasabunutan kita. . . ay
intention kuklulutin lang kita
• Plastic
• Love turns to hate and
hate into love.
REGRESSION • Return to an earlier • Return to thumbsucking
developmental stage
REPRESSION • Unconscious forgetting of an • Hindi ko maalala
anxiety provoking concept
• A woman who was
sexually abused as a
young child can’t
remember the abuse
but experiences uneasy
feelings when she goes
near the place where
the abuse occurred.

39. ANXIETY

40. ANXIETY
MSN
GILBERT
Definition:
 Subjective, individual experience
characterized by a feeling of
T. SALACUP
apprehension, uneasiness, uncertainty, or
dread.
 Occurs as result of threats may be
- Actual or imagined,
- misperceived or misinterpreted,
- threat to identity or self-esteem.
 It often precedes new experiences.

41. MSN
GILBERT
Types of Anxiety:
 Normal
A healthy type of anxiety that
mobilizes a person to action.
T. SALACUP
 Acute
Precipitated by imminent loss or
change that threatens the sense of
security.
 Chronic
Anxiety that the individual has lived
with for a long time.

42. MSN
GILBERT
Levels of Anxiety:
1.Mild/ Aler tness Level (+1)
- Nor mal Type of Anxiety
P -erceptual field increased
A - lert
T. SALACUP
R - estless
I - ncreases learning
Nursing Interventions:
- Recognize the anxiety by statements such as
“I notice you being restless today”.
-Explore causes of anxiety and ways to solve problems
“Let’s discuss ways to…”

43. 2. Moder ate/ A pprehension Level
MSN
GILBERT
(+2)
The response of the body to immediate danger and focus is
directed to immediate concerns.
T. SALACUP
S - elective inattentiveness occurs
I - ncreased tension optimal time for learning
N - arrows the perceptual field
U - ses palliative coping mechanisms.

44. MSN
GILBERT
Nursing Interventions:
1. Provide outlets for anxiety such as crying or talking.
2. Tell client “It’s all right to cry”.
3. Encourage in motor activity to reduce tension.
4. Make client be aware of his behavior and feelings by
T. SALACUP
statements such as “ I know you feel scare…”
5. Encourage client to move from affecting (feeling) to
cognitive mode (thinking).
6. Refocus attention
7. Encourage the client to talk about feelings and
concerns.
8. Help the client identify thoughts and feelings that
occurred prior to the onset of anxiety.
9. Provide anti-anxiety oral medications.PRN Meds

45. 3. Severe/ Free-floating Level
MSN
GILBERT
(+3)
Creates a feeling that something bad is about to
happen, or feeling of an impending doom.
T. SALACUP
D - ilated pupils, fixed vision
F - ight and flight response sets in
A - ll behaviors are directed at alternative the anxiety
N - arrow perceptual field occurs.
T - he person uses maladaptive coping mechanisms.
I - ndividual needs direction to focus
Don’t know what to do
Don’t know what to say

46. Nursing Interventions:
MSN
GILBERT
1. Do not focus on coping mechanisms
2. Stay calm and stay with the client
3. Give short and explicit direction
T. SALACUP
4. Provide IM anti anxiety medications.
5. Modify the environment by
 S- etting limits or seclusion,
 I -nteraction limit with others,
 R - educe environmental stimuli to calm
client.

47. 4. Panic Level (+4)
MSN
GILBERT
I- f prolonged, panic can lead to exhaustion and death
S - uicide
P-ersonality and behavior is disorganized
T. SALACUP
I - nability to concentrate
T-he person uses dysfunctional coping mechanisms.
F- eelings of helplessness and terror
U - nable to communicate or function effectively
L - essens perception of the environment to protect
Nursing Interventions:
Safety
Guide patient step by step to action
Restrain if necessary.

48. ANTI-ANXIETY drugs
Benzodiazepines - Zolam – Zepam
1. F - lurazepam(dalamne) 7. T - riazolam(Halcion)
2. O - xazepam(Serax) 8. A - lpraZolam (Xanax)
3. L - orazepam(Antivan) 9.Chlo -rdiazepoxide(librium)
4. D - iazepam(Valium) 10.Chlo - razepate(Tranxene)
5. C - lonazepam(Klonopin)
6. T - emazepam(Restoril)
Non Benzodiazepines:
Buspirone (Buspar)
Meprobamate ( Miltown, Equanil)

49. Assess: Level of Anxiety
MSN
GILBERT
Nx Dx: Ineffective Individual Coping
Powerlessness
Impaired Skin Integrity
T. SALACUP
Planning/ Implementation:
↓ level of anxiety
↓ environmental Stimuli
Relaxation Technique
Evaluation : Effective individual coping

50. MSN
GILBERT
GENERALIZED ANXIETY DISORDER
- 6months excessive worrying
- Might be mild, moderate and severe anxiety
S/Sx
S - leep Disorders
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P - alpitations
E - dge of the seat
E - asy fatigability
R - estless
D - ifficulty of concentration

51. MSN
GILBERT
PANIC DISORDER
- recurring severe panic attacks
15 – 30 Minutes escalation of Somatic NS
Phobia
Phóbos, meaning "fear" or "morbid fear"
T. SALACUP
Types of Phobias
1. Agoraphobia - fear of open space/ public places
2. Social Phobia - Also called Social Anxiety Disorder
fear of public /presence of others.
3. Specific Phobia - Also called Simple Phobia
A persistent fear of a specific object or situation, other than of
two phobias mentioned above.

52. Risk Factors
MSN
GILBERT
Learning theory
phobias are learned and become conditioned responses
Cognitive theory
anxiety-inducing self-instructions of faulty cognitions.
Life experiences
T. SALACUP
Certain life experiences, such as traumatic events
Signs and Symptoms
W - ithdrawal
H - igh levels of anxiety
I - nappropriate behavior used to avoid the feared
situation, object or activity
D - ysfunctional social interactions and relationships
E - nability to function and meet self-care needs

53. Nursing Diagnoses
MSN
GILBERT
Anxiety
Powerless
Ineffective individual coping
Impaired verbal communication
T. SALACUP
Altered thought processes
Self-esteem disturbance
Impaired social interaction
Risk for injury
Therapeutic Nursing Management
Systematic desensitization
This process of gradual exposure to phobic object or situation

54. POST TRAUMATIC STRESS DISORDER
MSN
GILBERT
S - oldier
T - rauma
E – arthquake
T. SALACUP
W – ar VICTIMS 
Survivors
A - ccident
R - ape Flashback
D – isaster Nightmares

55. SOMATOFORM
- no pretension, suggest medical diseases
-no organic basis to support the illness.
Types of Disorder
1. Somatization disorder - chronic syndrome is
characterized by multiple somatic symptoms that
cannot be explained medically.
 The physical symptoms are associated with
psychological stress.
2. CONVERSION DISORDER
Nervous System
La Belle Indifference
 emotional disattachment from disability

56. Sleep disorder
MSN
GILBERT
This is characterized by difficulty initiating or
maintaining sleep.
Hypersomnia - or excessive sleepiness,
T. SALACUP
Narcolepsy - is a chronic sleep disorder, or dyssomnia,
--- excessive sleepiness and sleep attacks at
inappropriate times, such as while at work
Parasomnias - involve abnormal and unnatural
movements, behaviors, emotions, perceptions,
- dreams that occur while falling asleep
- sleeping, between sleep stages,
- during arousal from sleep.

57. Hypochondriasis
MSN
GILBERT
This is a person’s unwanted fear or belief that he or
she has a serious disease without significant pathology.
 Minor Discomfort Interpreted as major illness
Body dysmorphic disorders
T. SALACUP
 The client is preoccupied with an image defect in appearance when
there is no abnormality. Illusion of structural defect
 Client obsesses about imaged bodily defects (facial flaws,
heavy buttocks or thighs)
Pain disorder
 The pain is unrelated to a medical disease.
 The individual experiences severe pain that is in
disproportion to the originating source.


58. MSN
GILBERT
Risk Factors
Gender: Female
Age: Children and older adults
T. SALACUP
Nursing Diagnoses
Impaired adjustment
Chronic pain
Sleep pattern disturbance

59. PSYCHOSOMATIC
MSN
GILBERT
1. to a physical disorder that is caused by or notably
influenced by emotional factors.
2. pertaining to or involving both the mind and the body.
4 major types
T. SALACUP
H - ypertension
A - sthma
M - igraine
S - tress Ulcer
- Real pains/ illness
- Real symptoms

60. Obsessive Compulsive Disorder (OCD)
MSN
GILBERT
persistent thought and urges to perform repeated acts or
rituals releasing tension
Obsession
recurrent and persistent thoughts, impulses, images that
are intrusive, disturbing, inappropriate, and usually
T. SALACUP
triggered by anxiety.
Compulsion
Repetitive behaviors or mental acts that a person feels
driven to perform, specifically defined routine.

61. Thinking (Belief) → Mind-set
MSN
GILBERT
Windows open → ↑ Anxiety
Akyat bahay gang magnanakaw
T. SALACUP
Obsession (thought/thinking ) ↑ anxiety(thought)
↓
Compulsion (Action) ↓ Anxiety
Check the house

62. Specific Biological Factor
MSN
GILBERT
 OCD is linked to a deficiency in serotonin.
 Abnormalities in frontal lobes and basal ganglia
Signs and Symptoms
Ruminations – forced preoccupation with thoughts about a
particular topic, associated with brooding and inconclusive
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speculation.
Cognitive rituals – mental acts the client feels compelled to
complete.
Compulsive motor rituals – elaborate rituals of everyday
functioning such as grooming, dressing, eating,
Other symptoms – chronic anxiety, low self-esteem, difficulty
expressing positive feelings and depressed mood.

63. MSN
GILBERT
4 Defense Mechanism by OCD
R - epresion
T. SALACUP
I - solation
R - eaction formation
U - ndoing

64. Nursing Interventions
MSN
GILBERT
 Provide time to perform the rituals
 Limit, but do not interrupt, the compulsive acts.
 Teach to use alternate methods to decrease anxiety.
 Client’s behavior maybe frustrating to staff and family.
T. SALACUP
Power struggles often result. Consistency to the
approach to care is critical.
 Assess the client’s needs carefully.
 Provide an environment that has structure and
predictability as a strategy to decrease anxiety.
 Risk associated with the use of alcohol and drug abuse.

65. DISORDERS
 defined as the totality of a
person’s unique biopsychosocial
and spiritual traits that
consistently influence behavior.
1. Interpersonal relations that
ranges from distant to
overprotective.
2. Suspiciousness
3. Social anxiety
4. Failure to conform to social
norms.
5. Self-destructive behaviors
6. Manipulation and splitting.

66. Cluster A:Personality Disorders(The Eccentric and Mad group)
MSN
GILBERT
Paranoid – Moto wag magtiwala Sa iba
overly suspicious and mistrustful behavior
NX. Management
 Psychotheraputic task on dealing trust Issues
 Low dose Phenothiazine
T. SALACUP
SCHIZOID – Moto little emotion
N - ever had a best friend
B - elieves he can stand on his own
I - don’t want people
C - ares more about computers and pets
A - void groups and social activities  no enjoyment
NX management
 Gradual involvement Milleu and group therapy
 Focus on building trust

67. Schizotypal Personality Disorder-
MSN
GILBERT
 pervasive pattern of social and interpersonal deficits, with
cognitive and perceptual distortions and behavioral
eccentricities.
Clinical Manifestations:
 R - estricted range of emotions
T. SALACUP
 O - dd appearance (stained or dirty clothes, unkempt and disheveled)
 L - oose, bizarre or vague speech
 E - xpresses ideas of suspicions regarding the motives of others
 E - xperiences anxiety with people
 W - ander aimlessly
 I - deas or reference and magical thinking is noted
Nx Management
 Low dose of neuroleptic
 Involved activity with others

68. MSN
GILBERT
Cluster B: Personality Disorders
( The Erratic and Bad group)
ANTI - SOCIAL
 M - otto I break the law
 A - s a child,: steal, lie, always get reprimanded
T. SALACUP
 G - ood talker, charmer, witty manipulator
 A - dult – grand robbery, illegal activitist against the
law, drug addiction, drives fast, unsafe sex, thrill
seeker
Nx Management
 Firm Limit Setting
 Confront behaviors consistently
 Enforce consequences
 Group therapy

69. BORDERLINE PERSONALITY
DISORDER
- Most common personality disorder found in
clinical settings.
- Marked impulsivity.
- It is more common in females than in
males.
- Self-mutilation injuries such
as cutting or burning
Moto my life is an empty glass
Nx Management
 Promote safety
 Help client to cope and control emotions
 Teach social skills , Set limits
 Behavioral contracts decrease mutilation
 Empathy and group therapy

70. MSN
GILBERT
Narcissistic

I love myself Moto I am famous
 Insensitive, arrogant, use rationalization
 I am the best
T. SALACUP
 lack of empathy.
 Ambitious and confident
Nx management
 Teach client that mistake are acceptable
 Focus on here and now
 Teach client imperfection do not decrease worth

71. MSN
GILBERT
Histrionic
Excessive emotionality and attention-seeking behaviors
 excited, dramatic but manipulative
 Center of attention
 Highly suggestible and will agree with almost anyone
T. SALACUP
to gain attention
 Uses colorful speech, Tends to overdress
 Concerned with impressing others
Motto Ako ang bida
Nx management
 Facilitate expression
 + reinforcement for unselfish behavior

72. Cluster C: Personality Disorders
MSN
GILBERT
( The anxious and Sad group)
AVOIDANT = No people No trouble
 I avoid people, I fear criticism
 Have talent but no confidence
T. SALACUP
3 Pattern
 Social uneasiness and reticence
 Very Low self-esteem
 Hypersensitivity to negative reaction
Nx Management
 Promote Self Esteem
 Gradually confront fears Increase exposure to small groups

73. MSN
GILBERT
Dependent
Moto I can’t live without you
 ↓ self esteem , Pessimistic
 Poor decision making skills
 Uncomfortable and helpless when alone
T. SALACUP
 Has difficulty initiating or completing simple daily
tasks on their own
Nx management
 Teach problem solving and decision making skills
 NPR Goal increase assertiveness

74. Obsessive – Compulsive
MSN
GILBERT
I am Perfect, moto
 I am organized
 Perfectionist
 Provide time to do rituals
T. SALACUP
 Precise and detail-oriented
Nx Management
 Explore the feelings
 Teach patient mistakes are acceptable

75. MSN
GILBERT
Other related disorder
Depressive – Moto I think I'm gonno die again
Pattern of depressive cognition and behavior in variety of
context
 Occurs equally in men and woman
T. SALACUP
 Same behavior characteristic in major depression but less
severe .
 Recurrent thought of death
 Total disinterest in all activity
 Inability to express joy
 Self Criticism
Nx Management
 Assess self harm risk, provide safety
 Promote self esteem
 Increase involvement in activity

76. MSN
GILBERT
Passive Aggressive
Moto Oh yes Oh your not
 Always say yes but resistance is hidden
 1-3% IN GEN, POP. 2-8% IN CLINICALSET UP
 May appear cooperative even ingratiating
T. SALACUP
 Blame others for misfortune
Nursing management
 Teach relaxation techniques
 Assertiveness
 Teach expressing the feelings directly

77. Schizophrenia
MSN
GILBERT
S - tress – Diathesis Model
 Too much stress in the reality will lead client to
escape it and go to the fantasy world
T. SALACUP
 I - mpaired reality perception
 G - enetic vulnerability
 E - go disintegration
 B - iological Theory
 Dopamine level is High
 A - exact cause is unknown

78. Extremely complex mental disorder
MSN
GILBERT

 Recent research reveals that schizophrenia may be a
result of faulty neuronal development in the fetal brain,
which develops into full-blown illness in late
adolescence or early adulthood.
 Diagnosed in late adolescence or early adulthood.
T. SALACUP
Peak incidence of onset
 MEN - 15 to 25 years of age
 WOMEN - 25 to 35 years of age
 Rarely In childhood.

79. Negative or Soft Positive or Hard
MSN
GILBERT
symptoms symptoms
Flat affect Delusion
T. SALACUP
Lack of volition Hallucinations,
Social withdrawal or Grossly disorganized
discomfort thinking, speech, and
behavior

80. 1. Assess : Content of Thought
MSN
GILBERT
Nx Dx : Disturbed thought process
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve thought process
T. SALACUP
2. Assess : Hallucination/ Illusions
Nx Dx : Disturbed sensory perception
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Improve sensory perception

81. 3. Assess : Suspicious
MSN
GILBERT
Nx Dx : Risk for other directive behavior
Planning/ Implementation:
Present reality
Provide safety
T. SALACUP
Evaluation : Eliminate/ minimize risk for other-directed
violence
4. Assess : Suicidal
Nx Dx : Risk for self directive behavior
Planning/ Implementation:
Present reality
Provide safety
Evaluation : Eliminate/ minimize risk for self-directed
violence

82. MSN
GILBERT
Flight or Looseness
I am super star I am super star.
T. SALACUP
Gulay is malungay? Super star is Nora
Were are you. Nora is a gay
I love beer. Gay is man

83. 4 A’s
MSN
GILBERT
ffect  appropriate, inappropriate, flat,
blunt (incomplete emotion)
mbivalence  torn between 2 opposing forces
T. SALACUP
utism
ssociative Looseness

84. MSN
GILBERT
Magical Thinking - Believes to have a magical power
Echolalia  I repeat what you say  Parrots
Echopraxia  I repeat what you do
T. SALACUP
Word Salad  words, no rhyme
Clang Association  words with rhyme : Doom,
Kaboom, Bromm
Neologism  creation of new words olasta, labidada
Clarification  done in case of neologism

85. Delusion: fixed falls belief with no basis in reality
MSN
GILBERT
Persecutory  FBI will get me/ someone will
harm the Patient
Religious  I am Jesus, allah, budah
Grandeur  I am the king of the world.
Ideas of reference  MD are talking about me.
T. SALACUP
Concrete Association  pilosopo “ what will u use in
txting your calculator?”
Hallucinations Illusion
Stimulus Absent Present
Visual X √
Auditory X √
Tactile X √

86. Hallucinations Management:
MSN
GILBERT
H - allucinations
A – cknowledgment - I know the voices are real to you
R - eality orientation - But I don’t hear them
T. SALACUP
D - iversion - Lets walk
Take note
But if nothing in the preceding intervention are seen
= Assess what the voices are saying

87. TYPES OF SCHIZOPHRENIA
MSN
GILBERT
1. Paranoid - Suspicious Ideas of reference
 Tendency to be violent - Defense mechanism
 Mistrust→Scared→Withdrawn Projection
Nrsg. Int:
Build up trust:
T. SALACUP
 1 to 1
 short interaction
 frequent visit
 foods in sealed container
 meds wrapped
For violent pt.
- Doors open - Near the door - Don’t touch the pt.
- Eye contact - 1 arms length away -call reinforcement

88. MSN
GILBERT
Catatonic – abnormal motor behavior
Onset - Acute DFM - Repression
No – favorite word
I - niwan na posture, ganun forever
T. SALACUP
W - axy Flexibility
A - mbivalence
N - egativism
Treatment
 ECT
 Benzodiazepines (such as diazepam or lorazepam) for
catatonic schizophrenia.

89. MSN
GILBERT
Unclassified / undifferentiated
 Mixed Manifestation
 Can’t be classified
 1st paranoid, then disorganized then catatonic, etc etc
DFM – Regression
T. SALACUP
Residual
Recovering/ decrease S/S
No more positive s/sx, just withdrawn

90. MSN
GILBERT
Disorganized/HEBEPHRENIC
Bizarre behavior
DFM- Regression and Fantasy
 Sad but smiles
T. SALACUP
 Inappropriate affect
 No reaction
 Flat affect
 Flight of ideas
 Giggling
 Positive and Negative S/Sx

91. High Dopamine= Schizophrenia
MSN
GILBERT
Dopamine Acetylcholine
Antipsychotics = Dopamine goes down
T. SALACUP
If Acetylcholine Dopamine
Extra pyramidal Side Effects
AKATHISIA AKINESIA
Restless, inability to sit Muscle rigidity
Makati siya, ahh kati siya Ahh kiniss siya

92. DYSTONIA
MSN
GILBERT
3 features
TORTICOLLIS Wry neck
OCULOGYRIC CRISIS Fixed stare
OPISTHOTUNOS Arched back
TARDIVE DYSKINESIA
T. SALACUP
 Irreversible side effects of antipsychotics
 Lip smacking
 Tongue protruding
 Cheeks puffing
 NEUROLEPTIC MALIGNANT SYNDROME
 Hyperthermia among client taking antipsychotic
 Hyperthermia with muscle rigidity

93. MSN
GILBERT
Other Side Effects
 Photosensitivity
Sunscreen
Wide brimmed hat
 Agranulocytosis
T. SALACUP
Report immediately Sore throat
1st sign to appear

94. ANTIPSYCHOTIC AGENT–major tranc/nueroleptics
MSN
GILBERT
Sub classification:
Phenothiazines: Non Phenothiazines:
Thorazine – Tora Tora Haldol – Ha Idol
Prolixin – Pro ang lixi n Navane – Sundalo pangdagat
T. SALACUP
Mellaril – Mella nmaril Tegretol – Hayop yan Tegre tol
Serentil – on seren til mawala
Trilafon - Trila in Fonila
Stelazine - Nanood si stela Zine
Atypical
Clozaril – close sa reel! yeh
Seroquel – Sero kal talaga
Invega – in vega n natin mga sister
Isigaw ntin ang - Geodon

95. ANTI PARKINSON'S –management anti psychotic induce EPS
MSN
GILBERT
A tivan(lorazepam) - Ati - van
D iazepam(valium)- ang tunog nyan Dia - zepammmmm
I nderal(propanolol) – Inde – Ral ral rall
K emadrin(procyclidine)- Keme – Drin drin drin
T. SALACUP
A- akineton (biperiden)- ay nako mga baliw akin ne to
B- benadryl(diphenhydramine)- ben that’s a dryl
L- larodopa(Levodopa)- mmm Laro kc kau ng laro! D pa
E- Eldepryl (Selegilene)- ang sbi bi ni elde p reel kc kau akin n nga ung
S- symmetrel-(amantadine)- Sym Motor ko hmm bulol symmetrel
C- cogentin(Benztropine)-Sakay nlang kau sa coge tin
A- artane(trihexyphenidyl)- ang a artane kc nila
P- parlodel(Bromocriptine)- Para Lodel at nkarating na silang lhat end
Increase protein and give B6

96. Mood Disorder
MSN
GILBERT
Disturbance in mood ( Affect) that is either depression or elation
(mania = persistent hyperactive)
Bipolar - Mania more common
T. SALACUP
Results from disturbances in the areas of the brain that regulate mood
It involves periods of excitability (mania) alternating with periods of depression
 Men and women equally
 Usually appears between ages 15 – 25
Cause
 Unknown
 Stressful life
 Obese
It occurs more often in relatives of people with bipolar disorder
Ref. Videbeck Page 317

97. MSN
GILBERT
Risk factors
 Biochemical imbalances
 Family genetics – one parent, child has 25% risk; two parents, 50-75% risk.
 Environmental factors-such as stress, losses, poverty, social isolation.
 Psychological influences–inadequate coping, denial of disordered behavior
T. SALACUP
Specific Biological Factors
 Possible excess of norepinephrine, serotonin, and dopamine.
 Increased intracellular sodium and calcium
 Neurotransmitters supersensitive to transmission of
impulses
 Defective feedback mechanism in limbic system.

99. NORMAL, MANIA
2. BIPOLAR TYPE I – MANIC EPISODES AT LEAST 1 DEPRESSIVE
EPISODE
3. BIPOLAR TYPE II – RECURRENT DEPRESSIVE EPISODE AT LEAST 1
HYPOMANIC
EPISODE

100. Self Actualization =Task
MSN
GILBERT
Self Esteem = Nursing Role Restrain
Impaired social interaction = safety
T. SALACUP
Risk for injury/ other directed violence= safety
↓ Eating ↓ Sleep Hyperactive ↑ Sex
finger food Private room Anxiety

101. ↓SE → ↑Compensation → ↑interfere ADLs, ↑ harm others
MSN
GILBERT
↑SE → ↓Compensation → ↓interfere ADLs, ↓ harm others
TASK → increases client’s self esteem
 Escorted walk outdoors
 Punching bag
No group games  compitition will increase anxiety
T. SALACUP
3 or more signs confirms disorder
S - leeplessness
P- ressured speech
E - xaggerated SE
E - xtraneous stimuli (easily distracted)
D - istractibility
G - randiose
F - light of ideas

102. Therapeutic Nursing Management
MSN
GILBERT
 Environment
 Psychological treatment
 Individual Psychotherapy – may be used to
identify stressors and pattern of behavior.
 Group therapy – establishes a supportive
T. SALACUP
environment and redirect inappropriate behavior.
 Family therapy – verbalizes family frustration and
establishes a treatment plan for outpatient use.
 Somatic and Psychopharmacologic treatments
 electroconvulsive therapy
 Psychopharmacology

103. DEPRESSION  ↓ Serotonin
MSN
GILBERT
if unresponsive to drugs, ECT
Kubbler-Ross Stages of Dying / Grief Process
Denial “No not me”, “Its not true”, “Its not impossible”
Anger why me, why now, What did I do to deserve this?”
Bargaining  “If I live until Christmas or until my child’s
T. SALACUP
graduation ( So many if’s), I will do this…”
Depression  “Yes, I’m dying”
Acceptance  “Yes, I am ready”
↓Self Actualization
↓Self Esteem = Task
Withdrawn = stay
Risk for self directed violence
Eating Sleep Hypoactive ↓Sex

104. MSN
GILBERT
Major Depressive Disorder
2 or more weeks of sad mood
9 Symptoms
S –leep disturbance (insomia/hypersomia)
O – Vert Suicidal Ideation (Recurrent thoughts of deaths)
T. SALACUP
M – emory Disturbance (Indecisiveness)
E – nergy loss or Fatigue
A – gitation psychomotor
L – ost of interest/ Pleasure
O – bvious Wt Significance
N – ihilism – feeling of worthlessness
E – motional blanting and sad effect – depress mood
5/9 symptoms present 2 or more weeks 1 of which is depressed

105. Risk Factors
MSN
GILBERT
 Biological factors – brainchemicals
 Family genetics – parent with depression, child 10-13% risk of depression.
 Gender – higher rate for women
 Age – often less than 40 when begins
 Marital status – more frequently single, widowed
T. SALACUP
 Season of year – Seasonal Affective Disorder (SAD)
occurs when client experiences recurrent depression that
occurs annually at the same time.
 Psychological influences – low self-esteem, unresolved grief.
 Environmental factors – lack of social support, stressful life events.
 Medical co-morbidity – clients with chronic or terminal
illness, postpartum, and current substance abuse are
especially prone to becoming depresses.

106. Therapeutic Nursing Management
MSN
GILBERT
 Safe environment
 Psychological treatment
 Individual psychotherapy – long –term therapeutic approach or short term
solution-oriented, may focus on in-depth exploration, specific stress situations,
or problem solving.
 Behavioral therapy – modifying behavior to assist in reducing depressive
symptoms and increasing coping skills.
T. SALACUP
 Behavioral contacts – focus on specific client problems and need to help the
client resolve them.
 Social treatment
 Milieu therapy – day to day living experiences in a therapeutic environment
 Family therapy – aimed at assisting the family cope with the client’s illness
and supporting the client in therapeutic ways.
 Group therapy – focuses on assisting clients with interpersonal communication,
coping, and problem-solving skills.
 Psychopharmacologic and Somatic treatments
 Administer antidepressant medications
 Continued assessment interms of agitation and suicidal ideation.
 Electroconvulsive therapy

107. MSN
GILBERT
Nursing Interventions
1. Priority for care is always the client’s safety.
2. Use of behavioral contacts. “no self-harm” or no suicidal ideation or plan.
3. Assess regularly for suicidal ideation or plan.
4. Observe client for distorted, negative thinking.
T. SALACUP
5. Assist client to learn and use problem solving and stress management skills.
6. Avoid doing too much for the client, as this will only increase
client’s dependence and decrease self-esteem.
7. Explore meaningful losses in the client’s life.

108. MSN
GILBERT
ANTIDEPRESSANTS
S - inequan – Watch tau ng Sine Quan
A - nafranil – Ana Franil Pala
V - ivactil – Bi back tau agad after nuod ng
E - lavil – Ela evil
T. SALACUP
P - rozac – Pero sak a na
A - ventyl – Aveeen Til Midnight tayo
N - orpramin – Nor
T - ofranil – Tofra an kita
P - axil – Taksil ka
A - sendin – asan n din kau
Z - oloft – yan mag Solo ka

109. 1st Line of Drug Prescribed
MSN
GILBERT
afest
ELECTIVE Prozac(Fluxetine)
ide effects low
T. SALACUP
EROTONIN Paxil (Paroxetine)
EUPTAKE Zoloft(Sertraline)
note: No suicidal or
to 4 weeks Homicidal
NHIBITOR take in am to avoid insomnia

110. Two – 4 wks Sendin (Amoxapine)
MSN
GILBERT
Tri
orpramine (Desipramine)
CYCLIC ofranil (Imipramine)
T. SALACUP
inequan (Doxepine)
NTIDEPRESSANT Lavil
amelor
Higher incidence of Side effects Serotonin/ Epi affected
Neuro and hepatotoxisity,Cardiac Arrytmias
Suicide Precausion 10 -15 days precausion

111. ONO
MSN
GILBERT
arplan (isocarboxazid)
ardil ( Phenelzine)
Mine
T. SALACUP
arnate (Tranylcypromine)
Xidase
Nhibitor
All neurotransmitter affected Highest Side effects
Avoid tyramine rich food may lead to
HYPERTENSIVE CRISES

112. TYRAMINE RICH FOODS
MSN
GILBERT
vocado
ged Cheese
eer
hocolate
T. SALACUP
ermented Foods
ickles
reserved Foods
oy Sauce

113. LITHIUM
MSN
GILBERT
L evel 0.5 – 1 mEq/L
I ncrease urination
T remors, fine hand
H ydration 3 L/day
T. SALACUP
I ncrease Na+
Uu diarhea
M outh, dry
Maintenace level 0.5 – 1 mEq/L
Treatment level – 0.8 – 1.5 mEq/L
Toxic level – 1.5 above
Lithium Toxicity Nausea, vomiting, diarrhea

114. ELECROCONVULSIVE THERAPY

115. Nowadays, ECT is not only used for major depression,
MSN
GILBERT
but also for the treatment of:
 mania (in bipolar disorder)
 Catatonia (motion less or excessive motion)
 quick relief for self-destructive behavior
T. SALACUP
ECT only be indicated for the treatment of severely
depressed clients that needs fast relief
Can pregnant women undergo ECT?

116. MSN
GILBERT
Contraindications and precautions
 recent myocardial infraction
 stroke
 sever hypertension
 presence of intracerebral mass
T. SALACUP
Mechanism of action
 The therapy induces a therapeutic tonic seizure
(a seizure where the person loses consciousness and has
convulsions) which lasts for about 15 seconds.
It is believed that the shock intensifies brain chemistry to
correct the chemical imbalance in depression
(decrease serotonin and norepinephrine).

117. Frequency of treatment
MSN
GILBERT
 6-15 treatments are scheduled three times a week.
 6 treatments are needed to observe a sustained
improvement of depressive symptoms.
 Maximum effect or benefit is achieved in 12 to 15
treatments.
T. SALACUP
 70 – 150 volts
 .5-2 seconds Duration
 6-15 treatments
 48hrs interval

118. MSN
GILBERT
 Nursing Interventions
 Before ECT
1. Informed consent should be signed.
2. NPO post midnight.
3. Remove fingernail polish.
4. IV line initiation.
T. SALACUP
1. Atropine  dry mouth
2. Barbituate  short-acting anesthetic.
3. Succinylcholine  muscle relaxant, prevent seizure
5. Let the client void before the procedure.
 During ECT
1. Place electrodes on the client’s head on one side (unilateral) or
both (bilateral).
2. Brain monitoring through electroencephalogram (EEG).
3. Oxygen administration with an Ambu-bag.

119. After ECT
MSN
GILBERT
1. When the client is awake, reorient the client.
2. Obtain vital signs.
3. Assess client for the return of gag reflex.
4. Allow the client to eat (with a positive gag reflex).
T. SALACUP
 Side-lying – lateral
 S/E
 headache, dizziness,
 TEMPORARY MEMORY LOSS  distinct sign

120. Suicide
GILBERT
Definition
Self imposed
death
T. SALACUP RN, MSN
stemming from
depression

121. MSN
GILBERT
Verbal Non Verbal
• I wont be a problem • Take this ring, its
T. SALACUP
anymore yours (giving of
• This is my last day valuable)
on earth • Sudden change in
• I’ll soon be gone mood

122. Who will commit Suicide?
MSN
GILBERT
S - ex – Male (more successful)/ female (hesitant)
A ge – 15 –24 y/o or above 45
D epression
T. SALACUP
P atient with previous attempt
E ethanol - alcoholics
R irrational
S ocial support lacking
O rganized plan  greater risk
N o family
S ickness, terminal

123. SUICIDE TRIAD
MSN
GILBERT
1. Loss of spouse
2. Loss of job
3. Aloneness
T. SALACUP
Nursing Intervention
1. D irect question – “Are you going to commit suicide?”
2. I rregular interval of visit to pt. room
3. E arly AM and period of endorsement – the time pt’s
commit suicide

124. Best approach for suicidal pt. : Direct approach
MSN
GILBERT
Nursing Management: Close surveillance
Hospital quarter common suicide will come about
weekends - 1- 3 am Sunday
T. SALACUP
- few staff personnel
Early AM - every one is asleep
Simple task
 Water plants
 Wash the dishes except sharps
Don’t give complex - may cause depression ex. Puzzle

125. MSN
GILBERT
Cyclothymic disorder
Milder symptoms of both mania and
depressions often separated by long
periods of normal moods
T. SALACUP
Dysthymic Disorder
Long standing symptoms of depression
alternating with short periods of normal
moods clients can maintain normal roles
and jobs

126. EATING DISORDERS
Bulimia Nervosa
 The Diet-Binge-Purge Disorder”.
 dieting, binging and purging
through vomiting
 Rapid eating for about two
hours (over 8000 calories in 2
hours and 50,000 in 1 day)
 Methods of controlling weight
(diet pills, excessive exercise,
enemas, diuretics, laxatives),
 Weight normal or fluctuations
are due to alternating fasting
and binging

127. Ages 15-24 years.
MSN
GILBERT

 Bulimic often belong to a family and society that place
great value on external appearance.
 self hatred
 low self-esteem,
 symptoms of depression,
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 fear of losing control,
 suicide tendencies.
 Perfectionist, achievers scholastically and
professionally.
 They hide their disorder because of fear of rejection.
 Person is aware that the behavior is abnormal, b.
 After the episode she becomes guilty and depressed

128. GILBERT T. SALACUP RN,
MSN

129. Nursing Diagnosis
MSN
GILBERT
1. Alterations in health maintenance.
2. Altered nutrition: Less than body requirements.
3. Altered nutrition: More than body requirements
4. Anxiety
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5. Body image disturbance
6. Ineffective family coping; compromised
7. Ineffective individual coping
8. Self-esteem disturbance

130. During interview Nursing Interventions
MSN
GILBERT
 to gain trust and acceptance of nurses. Create an
atmosphere of trust.
 Develop strength to cope with problems. Encourage
patient to discuss positive qualities about themselves to
increase self-esteem.
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 Help patient identify feelings and situations associated
with or that triggers binge eating.
 Encourage making a journal of incident and feelings
before-during and after a binge episode.
 Make a contract with the patient to approach the
nurse when they feel the urge to binge
 Encourage adhering to meal and snack schedule of
hospital.
 Cognitive behavioral therapy is the ideal therapy

131. ANOREXIA NERVOSA
Starvation and Emaciation
 is a disorder with an insidious
onset that often affects adolescent
girls.
 upper middle class families.
youngest child is affected.
 uses denial
 10-20 % of anorexics die and half
of these deaths are due to suicide.

132. Nursing Interventions
MSN
GILBERT
 Cognitive and Behavioral therapy to positive and negative reinforcement:
 focus is on client’s responsibility to gain weight.
 Privileges are gained with weight gain.
 Privileges are lost with weight loss.
 Increase self-esteem
 Teach about the disorder.
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 Monitor weight three times a week but weigh with the patient facing away
from the weighing scale
 As soon as the ideal weight is gained, allow patient to regulate his or her
own progression and program.
 High protein and high carbohydrate diet, serve foods the patient prefer in
small frequent feedings. NGT if the patient refuses to eat.
 Setting limits to avoid manipulative behavior:
 Restrict use of bathroom for 2 hour after eating.
 Accompany to the bathroom to ensure that they will not self induce
vomiting.
 Stay with client during meals.
 Do not accept excuses to leave eating area.

133. Anorexia Eating Bulimia
MSN
GILBERT
Nervosa Disorders
Diet, diet, diet Eating Pattern Eat, eat, vomit
<85% of expected Weight Normal weight
body
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3 mos. Menstruation Irregular menstruation
amenorrhea
Karen Carpenter Dao Ming Su
Da Ming Sugat/ suka
Vomiting
Dental caries
Wounded knuckles
Metabolic alkalosis
Metabolic acidosis

134. MSN
GILBERT
Paraphilias
 Paraphilias are complex psychiatric disorders that are
manifested as unusual sexual behavior.
 Diagnostic and Statistical Manual of Mental Disorders,
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Text Revision (DSM-IV-TR) defined it as a “recurrent,
intensely sexually arousing fantasies, sexual urges, or
behaviors generally involving:
 S = uffering or humiliation of oneself or partner
 I = nanimate objects (non-human objects)
 N = onconsenting person
 C = hildren

135. Eight specific disorders of paraphilia
MSN
GILBERT
 Exhibitionism – Exposing one’s genitals to strangers
or masturbating in public areas.
 Fetishism – (Pa suot) inanimate objects to achieve
orgasm women’s undergarments (brassiere, lingerie,
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and panty), shoes and other apparels.
 Frotteurism – (Pa Touch) urges of touching or
rubbing against a non consenting.
 Pedophilia – a sexual activity done with a child 13
years younger is a characteristic of this disorder. at
least 16 years old or at least 5 years older than the
victim.

136.  Sexual masochism – (Saktan mo ako) the
MSN
GILBERT
intense and persistent sexual urge involving acts
of suffering (beaten or bound) and
being humiliated.
 Sexual sadism – (Sasaktan kita) sexual urge
involving acts in which the pain, suffering or
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humiliation of a partner is arousing a person.
 Transvestic fetishism – sexual fantasies, urge
and behaviors involving cross-dressing by a
heterosexual male.
 Voyeurism – sexual arousal by observing an
unsuspecting person who is naked, in the
process of undressing or engaging in sexual
activity.

137. SUBSTANCE ABUSE

138. ALCOHOLISM - state of alcohol addiction
MSN
GILBERT
Etiology:
Intergenerational Transmission
From one generation to another generation
Alcohol
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↓
Blackout  awake but unaware
↓
Confabulation  inventing stories to ↑ self-esteem
↓
Denial  “I am not an alcoholic”
Dependence  “I can’t live without it”
↓

139. Enabling  significant other tolerates abusers
MSN
GILBERT
Another term CO – DEPENDENCY
TOLERANCE  ↑ Substance to achieve a previous
effect
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DETOXIFICATION
 Withdrawal with MD supervision
 Safe withdrawal is accomplished through the
administration of benzodiazepines such as
Chlordiaxepoxide (Librium), Lorazepam (Ativan) or
Diazepam (Valium) to suppress the withdrawal
symptoms
 Check Alcohol, Mouthwash, Elixir

140. void alcohol
MSN
GILBERT
version therapy
lcoholics Anonymous  self help group
ntabuse  DISULFIRAM  Never drink alcohol
↓ 12 hour interval/ 12 h last alcohol intake
B1 Vitamin Deficiency or else: nausea, vomiting and hypotension
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↓ Wernicke’s Encephalopathy → motor
Complications
↓ Korsakoff’s Psychosis → memory
Delirium Tremens  24 – 72 h after last dose of alcohol
↓ untreated withdrawal syndrome
ormocation  bugs crawling under the skin
amily Therapy  mother, father, brother

141. SUBSTANCE ABUSE
MSN
GILBERT
Downers -
B - arbituates Morphine
O - piates Codeine NARCAN  antidote
N - arcotics Heroine
A – lcohol
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Uppers (Hac - S)
 Hallucinogens
 Amphetamines
 Cocaines

142. LEVELS OF MENTAL RETARDATION
MSN
GILBERT
Profound
 Less 20 IQ
 thinks like an infants
 can’t be trained
 Some speech
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Severe - 20 – 35
 IQ May learn Talk and communicate
 Perform simple task elementary hygiene
Moderate - 35 – 50 IQ
 can be train
 mental age is 2 – 7 y/o
 pre-operational stage


143. 4. Mild
MSN
GILBERT
 50 – 70
 meantal age is 7 – 12
 educable
 can go to school
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5. Borderline
 70 - 90
6. Normal
 90 – 100
Mental Retardation
 IQ Less than 70
 Onset before 18 yrs/old
 Not often detected until school age
 Impaired learning and social adjustment

144. Nursing Intervention
MSN
GILBERT
 Role Modeling
 Repetition
 Remorivation
 Provide sensory stimulation
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AUTISM/Kanner Syndrome/ Pervasive devt. Dis.
With a special talent /Head banging and head rocking
 Diagnose at 2 Y.O. Appears at 3 y.o.
 4x more common in male than in female
Assess
Appearance - flat affect, consistent movement
Behavior - repetitive, ritualistic
Communication - echolalia, incomprehensible

145. Nursing diagnosis
MSN
GILBERT
 S -elf mutilation
 I - mpaired verbal communication
 R -isk for injury
 I - mpaired social interaction
Nursing Intervention
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 Priority Safety,security supervision
 Counseling
 Education
 Expressive therapy - drawing, muscic etc
 Improved social interaction
Meds:
Anti Psychotics: Haldol,risperidone=tempertantrums
Naltrexone(revia)Anafranil,Clonidine(catapres)= hyperactivity

146. ATTENTION DEFICIT HYPERACTIVE DISORDER
MSN
GILBERT
 Onset : before 7 y.o.
 Episode : 6 months and above
 Settings : 2 House and school
 Id Dominant : Mom or RN will act as superego
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Assess
C - ommunication - talkative, blurts out in class
R - estless
I - mpulsive
D - ecrease attention span
E - asy distractibility
Nursing Diagnosis
Risk for injury
Impaired social interaction

147. Nursing Intervention
MSN
GILBERT
 Priority safety and Nutrition
 Structure separate room for eating, playing, sleeping
and etc
 Schedule - time for everything
 Slimits
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 Ignore Temper tantrums
 Finger foords
Meds: for 6 Y.O. Ritalin,, pemoline, adderal
3 Y.O and Above dexedrin
Best time to give: once a day:
AFTER MEALS: prevent lost of appetite
Don’t give at bedtime  STIMULANT  causes insomnia
Give 6 hours prior bedtime if bid

148. ALZHEIMER
MSN
GILBERT

 NOMIA  don’t know name of objects
 GNOSIA  problem with senses
 PHASIA  can’t say it
 PRAXIA  can’t do it
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149. GILBERT T. SALACUP
MSN

150. GILBERT T. SALACUP
MSN

151. Domestic Violence
MSN
GILBERT
CHILD ABUSE
Burns, bruise, bone fractures
Excessive Knowledge of sex/Violence
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Depression
Apathy no reactions
Bantay Bata 163
Don’t bathe the child, don’t brush teet.
Body of evidence will be lost

152. Types
MSN
GILBERT
Violence- implies only the use of physical force
Neglect – Child abandonment, insufficient Childs needs
for survival
Physical Abuse – abuse in the form of inflicting pain
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Emotional abuse – form of insults mind game
Sexual abuse- unwanted sexual contact
Nursing management
 Safe , secutiy, supervision
 Proper reporting of child abuse – w/ in 48hrs Brgy
captain, DSWD, Police
Play therapy

153. Rape
MSN
Crime lack of consent, treat, force and sexual penetration
Sexual assault - Forcible sexual acts lack of consent, against his or her will
3 essential elements of rape
 Vaginal penetration
 Use of force , intimidation, treat
 Lack of consent
Rape trauma syndrome
Immediate acute phase
Displays 2 type of emotion (disorganization)
Controlled
Expressed

154. Long term process (reorganization) 3-4wks
MSN
GILBERT
 Flash backs in dreams and night mares
 Development of phobia
 Self guilt
Crisis Intervention
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 Crisis is a situation or period in an
individual’s life that produces an
overwhelming emotional response.
 stressor that he or she cannot
effectively manage by using his or her
usual coping skills.

155. Type of Crisis
MSN
GILBERT
 Maturational crisis – also called developmental crisis.
These are predictable events in a person’s life which
includes getting married, having a baby and leaving
home for the first time.
 Situational crises – unexpected or sudden events
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that imperils ones integrity. Included in this type of
crisis are: loss of a job, death of a loved one or relative
and physical and emotional illness of a family member
or an individual.
 Adventitious crisis – also called social crisis.
Included in this category are: natural disasters like
floods, earthquakes or hurricanes, war, terrorist
attacks, riots and violent crimes such as rape and
murder.

156. Guide for an effective crisis intervention:
MSN
GILBERT
 Assist the person to view the event or issue in a
different perspective.
 Assist the individual to use the existing support
systems. It is vital to help the person find new sources
of support that can help in decreasing the feelings of
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being alone or overwhelmed.
 Assist the individual in learning new methods of coping
that will help resolve the current crisis and give him or
her new coping skills to be used in the future when
dealing with another overwhelming situation.